Members of the U.S. Preventive Services Task Force have concluded that there is still insufficient evidence to recommend PSA screening in men 75 years of age or younger. The details of these recommendations were published in the August 5, 2008 issue of the Annals of Internal Medicine.¹ 

Prostate cancer is the second leading cause of cancer death in the United States. Prostate specific antigen (PSA) testing is becoming routine after the age of 50-55, despite the fact that early diagnosis has not been clearly shown to improve survival. There is currently an ongoing randomized trial (The Prostate, Lung, Colorectal Trial) that has recruited more than 154,000 men, ages 55-74. Patients in this trial were randomized to a screening PSA or usual care arm. While this study is maturing, there are conflicting guidelines on whether or not PSA screening should be performed or not. However, PSA screening every one to four years has become relatively routine for American males. The last recommendations by the U.S. Preventive Services Task Force were in 2002. They concluded that there was insufficient evidence to recommend for or against PSA screening in men at average risk for developing prostate cancer.

These researchers reviewed the literature on PSA screening between 2002 and 2007.² These authors concluded that “no good-quality randomized, controlled trials of screening for prostate cancer have been completed.” They also identified two studies that suggested that false-positive PSA screening results caused “psychological adverse effects for up to 1 year.” They concluded that the “natural history of PSA-detected prostate cancer is poorly understood.” They concluded, “Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.” Thus, this task force did not make recommendations for or against PSA testing for men 75 years of age or younger but they did recommend no PSA testing in men over the age of 75 years.

Comments: These recommendations are unlikely to have a major impact on the current relatively high rate of PSA screening in healthy males over the age of 40 or 50 years. Many men are choosing to have PSA testing despite the potential psychological risks and questions about benefit.

Related News:

PSA Screening for Prostate Cancer in Men Aged 45-50 Years Reported (12/5/2007)

PSA Screening in Elderly Men Is Excessive (11/16/2006)

Ninety Percent of Prostate Cancers Detected by PSA Screening are Deemed Clinically Significant (3/24/2006)

Does PSA Screening Improve Survival? (1/13/2006)

Annual Testing Not Necessary for Men with PSA Levels Below 1.0 ng/mL (9/19/2005)

Case-Control Study Suggests PSA Screening Decreases Risk of Metastatic Prostate Cancer (8/29/2005)

No PSA Level has High Specificity and Sensitivity for Detection of Prostate Cancer (7/14/2005)

Incidence of Prostate Cancer in Men with PSA Levels <4 Defined (6/1/2004)

Older Patients are Over Tested for Prostate-Specific Antigen (PSA) (12/10/2003)

Prostate Mortality Decline Likely Due to PSA Testing (3/10/2003)

Screening with Prostate Specific Antigen (PSA) Results in Significant Overdiagnosis of Prostate Cancer (7/8/2002)

Selective PSA Screening Among Men with a Positive Family History of Prostate Cancer Not Rewarding (6/10/2002)

Men with Prostate Specific Antigen (PSA) Levels Less Than 2.0 Do Not Need Annual Testing (5/24/2002)

Reference:

¹ U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2008;149:185-191.

² Benefits and harms of prostate-specific antigen screening for prostate cancer: An evidence update for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2008;149:192-199.