The U.S. Preventive Services Task Force (USPSTF) recently drafted a grade D recommendation against prostate-specific antigen (PSA) screening for prostate cancer; however, it is unclear how this will affect screening practices since their previous recommendation appears to have been ignored, according to a research letter published in the Journal of the American Medical Association.
Each year in the United States, more than 192,000 men are diagnosed with prostate cancer and more than 27,000 die of the disease. In the U.S., men older than 50 are often offered PSA testing for the early detection of prostate cancer. The PSA test measures proteins that are produced and shed by the prostate. PSA levels tend to be elevated when prostate cancer is present, but levels can also be elevated in benign (non-cancerous) conditions affecting the prostate.
One concern with the use of PSA testing is that it may identify some cancers that do not require treatment. This is sometimes referred to as “overdiagnosis.” Research suggests that some prostate cancers are very slow growing and will not affect a man’s health during his lifetime. Diagnosis and treatment of these cancers exposes men to the complications of cancer treatment without providing a benefit.
In 2008, the USPSTF issued a grade D recommendation against PSA-based screening for men aged 75 years or older. There is a limited chance of benefit in screening older men. Researchers have since evaluated changes in national screening rates both before and after this recommendation. They found that screening rates were unchanged in all age groups over time. In 2010, PSA screening was more common in men aged 75 years or older than in men aged 40 to 49 years and men aged 50 to 59 years, but not in men aged 60 to 74 years.
The reasons for the discrepancy between the USPSTF recommendation and subsequent practice patterns are unclear. The researchers speculate that the discrepancy “may reflect lack of guideline awareness, financial incentives, or patient or physician confidence in PSA screening.” They suggest that it will be important to monitor the clinical practice patterns following the 2011 USPSTF recommendation in order to evaluate screening rates.
Prasad SM, Drazer MW, Huo D, et al. 2008 US Preventive Services Task Force recommendations and prostate cancer screening rates. JAMA. 2012; 307(16): 1692-1694.
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