In a sharp departure from its 2012 recommendations, the influential U.S. Preventive Services Task Force (USPSTF) in April issued a draft updated recommendation that men ages 55 to 69 should make individual decisions about being screened for prostate cancer. USPSTF’s highly controversial 2012 recommendation advised against routine screening in all men.
The updated recommendation came after USPSTF reviewed new evidence that “increases confidence in the benefits of screening,” even though the potential benefits and harms are “closely balanced,” according to the panel. This C-grade recommendation means that there is “at least moderate certainty that the net benefit is small” and that patients will need to make screening decisions after having informed conversations with their physicians.
The updated recommendation covers all men who do not have signs or symptoms of prostate cancer, including those at average risk and increased risk.
The evidence review supporting the panel’s decision explored five questions, including whether there is direct evidence that prostate-specific antigen (PSA)-based screening reduces short- or long-term prostate cancer morbidity and mortality and all-cause mortality. The panel also looked at whether a prostate cancer risk calculator together with PSA-based screening more accurately identifies men with “clinically active” disease compared to PSA-based screening alone.
In another change from USPSTF’s 2012 recommendation, the new draft advises that men older than age 70 should not be screened as the potential benefits of screening don’t outweigh the harms. This D-grade recommendation means there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. The cutoff age for non-screening in the 2012 document is age 75.
The new draft recommendation hews closely to guidelines of the American Urological Association and American Cancer Society, which both call for shared decisionmaking between men and their physicians. USPSTF accepted comments on the draft recommendation through May 11; a final statement will be released after a review of this feedback.