What are the risks associated with Prostate (Prostate-Specific Antigen (PSA)) screening?

From the Guidelines

Prostate cancer screening carries significant risks, including false positives, overdiagnosis, and treatment-related complications, which can outweigh the potential benefits for most men, and therefore, men should carefully consider these risks before undergoing testing. The main risks associated with prostate cancer screening include false positives from PSA tests, which can lead to unnecessary anxiety and additional testing, such as prostate biopsies, which can cause complications like pain, bleeding, infection, and difficulty urinating 1. Overdiagnosis is also a significant concern, as many prostate cancers are slow-growing and may never cause symptoms or death, yet their detection often leads to treatment, including surgery and radiation, which can result in serious side effects like urinary incontinence and erectile dysfunction 1.

Some key points to consider when weighing the risks and benefits of prostate cancer screening include:

• The potential for false positives and the resulting anxiety and additional testing
• The risk of overdiagnosis and overtreatment of slow-growing cancers
• The potential side effects of treatment, including urinary incontinence and erectile dysfunction
• The importance of informed decision-making and shared decision-making with healthcare providers
• The need to consider individual risk factors, such as family history and age, when making decisions about screening

According to the American College of Physicians, clinicians should inform men between the ages of 50 and 69 about the limited potential benefits and substantial harms of screening for prostate cancer, and should not screen for prostate cancer using the prostate-specific antigen test in patients who do not express a clear preference for screening 1. The US Preventive Services Task Force also recommends against routine screening for prostate cancer in men under the age of 55 and over the age of 69, and suggests that men between the ages of 55 and 69 should discuss the potential benefits and harms of screening with their healthcare providers before making a decision 1.

Ultimately, the decision to undergo prostate cancer screening should be made on an individual basis, taking into account a man's personal preferences, risk factors, and medical history, and should be based on a thorough discussion of the potential benefits and risks with a healthcare provider. Men should carefully consider the potential risks and benefits of prostate cancer screening before undergoing testing, and should discuss their individual situation with their healthcare provider to make an informed decision.

From the Research

Risks Associated with Prostate Screening

• The risks of prostate cancer screening include false-positive test results, unnecessary biopsies, overdiagnosis, and overtreatment, as noted in 2, 3.
• These risks can lead to significant harms, such as erectile dysfunction, urinary incontinence, and bowel symptoms, with about 1 in 5 men who undergo radical prostatectomy developing long-term urinary incontinence and 2 in 3 men experiencing long-term erectile dysfunction 3.
• Overdiagnosis and overtreatment are also major concerns, as many men with prostate cancer may never experience symptoms and would not have known they had the disease without screening 3, 4.

Factors Influencing Screening Risks

• Age is a significant factor, with the USPSTF recommending against PSA-based screening for prostate cancer in men 70 years and older due to the increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment 3.
• Family history and race/ethnicity also play a role, with African American men and men with a family history of prostate cancer having an increased risk of prostate cancer compared to other men 2, 3.
• The use of active surveillance as a management approach for low-risk prostate cancer can help minimize the risks associated with overtreatment, with studies showing that it is a safe and effective way to manage the disease 5, 6.

Importance of Informed Decision-Making

• Informed and shared decision-making is crucial when it comes to prostate cancer screening, with patients and clinicians needing to discuss the potential benefits and harms of screening and treatment 2, 3, 4.
• Patients should be aware of the pros and cons of PSA testing and the fact that an informed choice is related to better patient outcomes 4.
• Clinicians should not screen men who do not express a preference for screening, and the decision to undergo periodic PSA-based screening should be an individual one, taking into account the patient's values, preferences, and health needs 3.