Screening for Prostate Cancer: The PSA Controversy
Controversy surrounds prostate cancer screening. Is it effective? What are the guidelines? In the ongoing series of articles celebrating National Prostate Cancer Awareness Month, Path Report looks into the debate to bring clarity for you.
Critics of PSA screening cite the risks of overtreatment of prostate cancer outweigh any benefit, particularly in patients with less than 10 years life expectancy. Let’s look at the major studies that are often quoted by those on both sides of the argument.
Two large randomized trials have looked at the effectiveness of PSA screening for prostate cancer and found differing results. The evidence for screening is based on the European Randomized Study of Screening for Prostate Cancer (ERSPC), which found screening reduces the risk to be diagnosed with metastatic prostate cancer.
In the United States Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial,
It was found that after 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.
Let’s look at the recommendations from the major societies.
UpToDate states the following:
●The American Cancer Society recommends PSA testing with or without DRE for average-risk men beginning at 50 years of age. Screening should not be offered to men with a life expectancy less than 10 years. The guidelines also recommend beginning screening discussions at age 40 to 45 in patients at high-risk of developing prostate cancer (eg, black men and men with a first-degree relative with prostate cancer diagnosed before age 65).
●The American Urological Association recommends against screening men younger than 40, and also does not recommend routine screening for average-risk men ages 40 to 54, men older than 70, or men with a life expectancy of less than 10 to 15 years.
●The United States Preventive Services Task Force updated its recommendations in 2012 to recommend that men not be screened for prostate cancer, concluding that there is moderate certainty that the benefits of such screening do not outweigh the harms.
●The Canadian Task Force on Preventive Health Care makes strong recommendations against screening for prostate cancer with PSA for men younger than 55 or older than 69, and makes a weak recommendation against screening with PSA for men ages 55 to 69.
●The United Kingdom National Screening Committee does not recommend screening for prostate cancer.
●The Australian Cancer Council states that the evidence does not support population-based screening and recommends a patient-centered approach that individualizes the decision.
●The European Society for Medical Oncology (ESMO) recommends against population based screening and in favor of an individualized approach using shared decision making.
●The Clinical Guidelines Committee of the American College of Physicians recommends that clinicians inform men ages 50 to 69 about the limited potential benefits and substantial harms of prostate cancer screening and only screen men who express a clear preference for being screened.
Despite differences, all recommend the importance of informed decision making between patient and doctor. What can you do?
Understand your risk factors.
Know your family history.
Discuss with your doctor the PSA test
Take control of your health. It is through informed decision making with your doctor that will ensure your continued health.