What are the current recommendations for prostate cancer screening?

From the Guidelines

Prostate cancer screening is generally recommended for men aged 55 to 69 years, with the decision to screen being an individual one based on a discussion between the patient and their healthcare provider about potential benefits and harms. Screening typically involves a prostate-specific antigen (PSA) blood test, sometimes combined with a digital rectal examination (DRE). Men at higher risk, including African American men and those with a family history of prostate cancer, should consider beginning discussions about screening earlier, around age 40-45 1. The recommended interval between screenings is typically 1-2 years for men who decide to be screened. Men over 70 or with less than a 10-15 year life expectancy generally should not be screened routinely, as the potential harms may outweigh the benefits 1.

Some key points to consider in the decision-making process include:

• The potential benefits of screening, such as early detection and treatment of aggressive cancers
• The potential harms of screening, including false positives leading to unnecessary biopsies, overdiagnosis of indolent cancers, and treatment complications such as incontinence and erectile dysfunction
• The importance of individualized decision-making, taking into account a man's risk factors, overall health, and personal preferences
• The need for shared decision-making between the patient and their healthcare provider, with a discussion of the potential benefits and harms of screening 1.

It's also important to note that the evidence on prostate cancer screening is continually evolving, and guidelines may change over time as new research emerges 1. However, the current consensus is that a balanced approach to screening, taking into account the potential benefits and harms, is the best way to maximize detection of clinically significant cancers while minimizing overtreatment of cancers that would never cause symptoms or death.

From the Research

Current Recommendations for Prostate Cancer Screening

The current recommendations for prostate cancer screening are based on various studies and guidelines.

• The US Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 years should discuss the potential benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer with their clinician 2.
• The USPSTF also recommends against PSA-based screening for prostate cancer in men 70 years and older 2.
• A study published in the Journal of the American Medical Association (JAMA) found that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened 2.
• Another study published in The Prostate found that the combination of a PSA test with a cutoff value of 4.0 ng/ml and a digital rectal examination (DRE) is most effective in screening for the early detection of prostate cancer 3.
• However, a more recent study published in European Urology Oncology found that digital rectal examination is not a useful screening test for prostate cancer, with a poor diagnostic performance in young men 4.

Screening Methods and Tools

• PSA-based screening is a common method used to screen for prostate cancer, but it has its limitations and potential harms, including false-positive results and overdiagnosis 2.
• DRE is another method used to screen for prostate cancer, but its diagnostic performance is poor, especially in young men 4.
• The use of percentage of free prostate-specific antigen (%FPSA) has been proposed as an alternative model for the detection of prostate cancer, especially in men with PSA levels between 2.51 and 4 ng/mL 5.
• Transrectal ultrasonography (TRUS) is also used in combination with PSA and DRE to improve the detection of prostate cancer 6.

Risk Factors and Target Populations

• African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared to other men 2.
• Men aged 55 to 69 years are considered to be at higher risk of prostate cancer and may benefit from PSA-based screening 2.
• Men older than 70 years are considered to be at lower risk of prostate cancer and may not benefit from PSA-based screening 2.