American Association for Clinical Chemistry
Better health through laboratory medicine
CLN Stat
By Bill Malone
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Despite the controversy that erupted when its draft recommendations were released last year, the United States Preventive Services Task Force (USPSTF) did not change its grade “D” recommendation against prostate-specific antigen (PSA) screening for prostate cancer in its final recommendation statement. The recommendation does not cover the use of PSA for surveillance after diagnosis or treatment of prostate cancer.
In laying out the case for its recommendation, USPSTF noted that it considered five randomized, controlled trials of PSA screening, but that no study found a difference in overall or all-cause mortality. USPSTF also focused on harms of screening. According to the task force, 1 man in 1,000 avoids death from prostate cancer due to PSA screening. However, for every 1,000 men who are screened, 30-40 will develop erectile dysfunction or urinary incontinence due to treatment and 2 will experience a serious cardiovascular event. For every 3,000 screened, 1 will die due to complications from surgery.
Many groups of surgeons, oncologists, and urologists came out against the USPSTF recommendation, contesting the task force’s interpretation of the clinical trails. They warned of a future of more men presenting with advanced disease who might have been treated earlier if screening had not been curtailed.
The most recent update on PSA testing from USPSTF came in 2008, when the task force found insufficient evidence to recommend screening for men younger than 75 years and recommended against screening older men.
More information is available from the USPSTF web​site​​.
 

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Bill Malone 
 
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