Changes in PSA recommendations this month by the American Urological Association’s (AUA) resulted in similarities with those of the US Preventive Service Task Force (USPSTF). The alignment may simplify patient-physician “shared decision making” with regards to PSA screening.
In 2012, the USPSTF’s statements concerning PSA caused an uproar because it discouraged routine PSA screening for most men. Prior to the PSA Recommendation Statement, the USPSTF reviewed all relevant, randomized, and controlled studies in the medical literature (studies using this design decrease the odds of mistakenly believing that outcomes from the study [which actually happened only because of chance] result from the procedure or treatment being reviewed). These studies failed to prove decreased prostate cancer deaths as a result of PSA screening. Further, the USPSTF found that nearly 80% of PSA screenings incorrectly suggested the presence of prostate cancer (when outlier ranges were between 2.5 and 4 μg/L).
According to the USPSTF, these “false prostate” cancer diagnoses resulted in long-lasting, psychological harm in the form of excessive, ongoing worry about cancer. Additionally, when PSA screening suggested the presence prostate cancer, biopsies commonly followed. All medical procedures carry risks. In the case of prostate biopsy, as many as one third suffered bleeding, pain, infection, temporary urinary difficulties, etc. Of those, about 1% were hospitalized.
Changes in PSA recommendations from the AUA also discouraged routine screening of some patients. Men under 40 typically need not be screened because prostate cancer risk is low. Additionally, PSA screening is considered unnecessary for 40- to 54-year-old men having only “average” prostate cancer risk. Routine PSA screening was not recommended in men over 70 or in those with a life expectancy of less than 10 to 15 years.
The AUA recommended shared decision making when the risks and benefits of PSA are unclear. If PSA screening is chosen, the AUA recommended doing it every other year in order to decrease false positive results. In men aged 55 to 69 years, PSA screening prevents one prostate cancer death for every 1,000 screens during the course of 10 years. Older patients enjoying “excellent” health may benefit from ongoing screening.
No changes in PSA recommendations were made by the AUA regarding patients reporting symptoms suggestive of prostate cancer or younger patients having high prostate cancer risks. Patients in higher-risk groups include men with a family history of prostate cancer and those of African-American descent. As these patients may benefit from screening, discussion is warranted.
The AUA is a member organization of Urologist Surgeons that promotes urological care through research, education, and health care policy advocacy. It maintains a presence in Washington, DC to promote urological interests and to challenge policies deemed to interfere with their provision of quality care. Learn more about the AUA here.
Created by Congress, the volunteer USPSTF members use the medical literature and quality of life measures to develop best practice Recommendation Statements for preventive care. A list of Recommendation Statements is here. Services are recommended only when potential benefits have been shown to outweigh risk of harm. The public is welcome to comment on developing recommendations and changes in PSA recommendations. A list of in-process recommendations is here. Learn more about the USPSTF here.
Read more in our Prostate Cancer Health Center.