Clinical Summary
Prostate Cancer: Screening, 2008
August 05, 2008
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
This document is a summary of the 2008 recommendation of the U.S. Preventive Services Task Force (USPSTF) on screening for prostate cancer. This summary is intended for use by primary care clinicians.
| Population | Men Younger Than Age 75 Years | Men Age 75 Years or Older |
|---|---|---|
| Recommendation | No recommendation Grade: I (Insufficient Evidence) |
Do not screen Grade: D |
| Risk Assessment | Prostate cancer is more common in older men, African Americans, and men with a family history of prostate cancer. The same uncertainties about the effects of screening that apply to other men also apply to these higher-risk men. | |
| Screening Tests | The prostate-specific antigen (PSA) test is more sensitive than the digital rectal examination (DRE). The conventional PSA test cut-point of 4.0 μg/L misses some early cancer. However, lowering the cut-point would increase the rate of false-positive results. Variations of PSA screening have not yet been demonstrated to improve health outcomes. | |
| Screening Intervals | If PSA screening reduces mortality, screening every 4 years may be as beneficial as annual screening. | |
| Interventions | Management strategies for localized prostate cancer include watchful waiting, active surveillance, surgery, and radiation therapy. There is no consensus regarding optimal treatment. | |
| Balance of Harms and Benefits |
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| For men younger than age 75 years, evidence is inadequate to determine whether screening improves health outcomes. Therefore, the balance of harms and benefits cannot be determined. |
For men age 75 years or older and for those whose life expectancy is 10 years or fewer, the incremental benefit from treatment of prostate cancer detected by screening is small to none. Therefore, the harms outweigh the benefits. |
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| Suggestions for Practice | Clinicians should discuss the potential benefits and known harms of PSA screening with their patients younger than age 75 years. Men in this age group should be informed of the gaps in the evidence, and their personal preferences should guide the decision of whether to order the test. | |
| Other Relevant USPSTF Recommendations | A list of USPSTF recommendations on cancer screening can be found at http://www.uspreventiveservicestaskforce.org. | |
For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement (including a summary of research gaps), and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.