US Preventative Services Task Force Formally Recommends Screening for Prostate Cancer
USPSTF in favor of PSA screening in men ages 55 to 69
Earlier this morning, the U.S. Preventive Services Task Force (USPSTF) released its final recommendation statement on Screening for Prostate Cancer. Given the response from prostate cancer specialists and the rise in prostate cancer since the recommendations against screening were released in 2012, it is not a surprise that the USPSTF maintained its upgraded recommendations in favor of prostate cancer screening. These final recommendations are in alignment with the AUA recommendations for men ages 55 to 69. The guidelines are also congruent with many medical societies including the the American Society of Clinical Oncology, American Cancer Society, the American College of Physicians, and the National Comprehensive Cancer Network.
What about at risk populations?
Unfortunately, the guidelines do not formally recommend increased screening in "at risk populations" such as men with a family history of prostate cancer or those with racial/ethnic backgrounds. African American men are nearly twice as likely to die of prostate cancer as white men Given the higher rates of aggressive prostate cancer in African American men, studies have shown that more aggressive PSA screening would provide q greater benefit to African American men than the general population. Many urologists, including myself, feel there is a benefit to screening African American before the age of 55. I am disappointed the task force did not go further to guide these at risk populations.
What about men over 70?
The USPSTF advised against screening in men over age 70 (Grade D). Again, I find these recommendations do not go far enough to guide clinicians and men at risk. Sure, many men at age 70 may not see a benefit to screening if they have other medical problems or issues. For many men, however, making it to 70 means you will live for on average 15 more years based on longevity calculators. There is no doubt that select older, healthier men garner a benefit from prolonged PSA screening. For men with an expected life expectancy greater than 10 years, I recommend my patients consider continued screening.
Benefits of the increased scrutiny to PSA screening?
Ever since the Task Force initially recommended against PSA screening in 2012, urologists were forced to re-examine our strategy for prostate cancer care. Many urologist, after reflecting on the new data, acknowledging that yes, not every prostate cancer needs to be treated and many men could actively monitor their cancer. In this way, the Task Force has helped to generate significant self-reflection in the urology community. I commend the Task Force for its continued review of PSA screening to provide the most reasonable and thoughtful clinical guidance that best align with and reflect prostate cancer research and care in the US.