USPSTF

Recommendation on
Prostate Cancer
Screening

Raigan Benny
Group 2
Semester 12
• Prostate cancer is a common cancer
in men

• PSA-based screening is widely

used to detect prostate cancer

• Benefits and harms of screening are

uncertain
Importance

1.Prostate cancer is one of the most common types of

cancer in men, with a lifetime risk of being diagnosed
of approximately 11% in the US.

2.Prostate cancer is often asymptomatic and may only be

detected through screening, as over 20% of men aged
50 to 59 years and over 33% of men aged 70 to 79 years
were found to have prostate cancer in autopsy studies.

3.Although the median age of death from prostate cancer

is 80 years, some prostate cancers are aggressive and
can lead to death.

4.African American men have a higher lifetime risk of

prostate cancer death compared to men of other
races/ethnicities.

5.Screening for prostate cancer can help detect the

disease early and improve outcomes, but the benefits
and harms of screening are uncertain and need to be
weighed carefully in individual cases.
Screening Test
1.PSA testing is the initial screening test for prostate
cancer, and an elevated PSA level may indicate the
presence of cancer.

2.However, an elevated PSA level can also be caused by

non-cancerous conditions such as benign prostatic
hyperplasia and prostatitis, leading to "false-positive"
results.

3.If a man has a positive PSA test result, he may undergo a

biopsy of the prostate to confirm the diagnosis of prostate
cancer.

4.The decision to undergo screening should be based on a

shared decision-making process between the patient and
the clinician, considering the uncertain benefits and
potential harms of screening.

5. Routine PSA-based screening is not recommended for

men aged 75 years or older
6. Other screening tests, such as DRE or prostate MRI,
have not been shown to be effective in reducing prostate
cancer mortality
Benefits of Early
Detection and Treatment
1.The goal of screening for prostate cancer is to identify
high-risk, localized prostate cancer that can be
successfully treated, thereby preventing morbidity and
mortality associated with advanced or metastatic prostate
cancer.

2.Adequate evidence from randomized clinical trials

(RCTs) suggests that PSA-based screening programs in
men aged 55 to 69 years may prevent approximately 1.3
deaths from prostate cancer per 1000 men screened over
approximately 13 years.

3.However, there is currently no evidence to support PSA-

based screening for prostate cancer in men aged 70 years
and older, as RCTs have consistently shown no benefit on
prostate cancer mortality in this age group.

4.The benefits of PSA-based screening for prostate cancer

in high-risk populations, such as African American men
and men with a family history of prostate cancer, remain
uncertain due to inadequate evidence.
Harms of Early Detection
and Treatment
1.The harms of screening for prostate cancer include
potential psychological harms, false-positive results, and
complications of prostate biopsy, such as pain,
hematospermia, and infection.

2.PSA-based screening may lead to the overdiagnosis of

prostate cancer in some men who would never have
developed symptoms during their lifetime, resulting in
unnecessary harms from diagnosis and treatment.

3.Harms of prostate cancer treatment include erectile

dysfunction, urinary incontinence, and bothersome bowel
symptoms, which can have a significant impact on a
man's quality of life.

4.Adequate evidence suggests that the harms of screening

and treatment are at least small, and in some cases,
moderate, particularly in men over the age of 70 due to an
increased risk of false-positive results, complications of
biopsy, and treatment-related harms.
Conclusion
1.The USPSTF does not recommend routine PSA-based
screening for prostate cancer, but rather recommends that
men make an individual decision based on their values
and understanding of the potential benefits and harms.

2.The net benefit of PSA-based screening for prostate

cancer in men aged 55 to 69 years is considered small for
some men, highlighting the importance of weighing
specific benefits and harms when making screening
decisions.

3.For men 70 years and older, the potential harms of PSA-

based screening for prostate cancer are considered to
outweigh the potential benefits, leading to the USPSTF
recommendation against screening in this age group.

4.The decision to screen for prostate cancer is complex and

should be based on individualized considerations,
including age, personal and family history, and values
regarding the potential benefits and harms of screening
and treatment.
Thank You