Screening for Prostate Cancer

Contemporary recommendations for prostate cancer screening all incorporate the measurement of serum PSA levels; other methods of detection, such as digital rectal examination or ultrasonography, may be included.

There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer, and that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man's lifetime (i.e., PSA-based screening results in considerable overdiagnosis).

Management strategies for localized prostate cancer include watchful waiting, active surveillance, surgery, and radiation therapy.

There is no consensus regarding optimal treatment.

The reduction in prostate cancer mortality 10 to 14 years after PSA-based screening is, at most, very small, even for men in the optimal age range of 55 to 69 years.

The harms of screening include pain, fever, bleeding, infection, and transient urinary difficulties associated with prostate biopsy, psychological harm of false-positive test results, and overdiagnosis.

Harms of treatment include erectile dysfunction, urinary incontinence, bowel dysfunction, and a small risk for premature death.

Because of the current inability to reliably distinguish tumors that will remain indolent from those destined to be lethal, many men are being subjected to the harms of treatment for prostate cancer that will never become symptomatic.

The benefits of PSA-based screening for prostate cancer do not outweigh the harms.

Recommendations on screening for other types of cancer can be found at http://www.uspreventiveservicestaskforce.org.

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