Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement (continued)
Table. PSA-Based Screening for Prostate Cancer*
|Why not screen for prostate cancer?
|What are the benefits and harms of screening 1000 men aged 55–69 y† with a PSA test every 1-4 y for 10 y?|
|Possible benefit of screening||Men, n|
|Reduced 10-y risk for dying of prostate cancer
Die of prostate cancer with no screening
Die of prostate cancer with screening
Do not die of prostate cancer because of screening
5 in 1000
4–5 in 1000
0–1 in 1000
|Harms of screening|
|At least 1 false-positive screening PSA test result
100–120 in 1000
|Prostate cancer diagnosis
110 in 1000
|Complications of treatment (of those who are screened)‡
Develop serious cardiovascular events due to treatment
Develop deep venous thrombosis or pulmonary embolus due to treatment
Develop erectile dysfunction due to treatment
Develop urinary incontinence due to treatment
Die due to treatment
2 in 1000
1 in 1000
29 in 1000
18 in 1000
<1 in 1000
PSA = prostate-specific antigen; USPSTF = U.S. Preventive Services Task Force.
* The table design is adapted from Woloshin and Schwartz (14). Calculations of the estimated benefits and harms rely on assumptions and are, by nature, somewhat imprecise. Estimates should be considered in the full context of clinical decision making and used to stimulate shared decision making.
† The best evidence of possible benefit of PSA screening is in men aged 55–69 y.
‡ The rate of complications depends on the proportion of men having treatment and the method of treatment. The table reflects a distribution of 60% surgical treatment, 30% radiation, and 10% observation (refer to below for more details about assumptions and references). Other harms of radiation, such as bowel damage, are not shown.
Note: Estimates of the number of prostate cancer deaths in screened and unscreened men are taken from the 11- and 13-year follow-up studies of the PLCO (23) and ERSPC (15) trials. False-positive rates for PSA tests are derived from the PLCO trial and the Finnish center of the ERSPC trial (47, 64). Information related to the harms of biopsy is derived from the work of Rosario and colleagues (6). The incidence of prostate cancer in a screened population is derived from the incidence seen in the screened group of the PLCO trial (23). Treatment rates for localized prostate cancer in the U.S. population are derived from the SEER database and the Cancer of the Prostate Strategic Urologic Research Endeavor registry (9, 10). Expected complication rates from prostatectomy and radiation therapy are derived from pooled estimates calculated in the evidence review done for the USPSTF (10).