Commentary by Cara Litvin MD, Executive Editor, Clinical Correlations
The US Preventive Services Task Force issued new guidelines for prostate cancer screening on Monday. For the first time, the task force recommends AGAINST routine screening in patients over 75 years of age, citing the “moderate to substantial” harms over small to no benefits from screening. The task force reports that there continues to be inadequate evidence that the PSA improves healthcare outcomes at any age. However, even if there is eventual evidence that screening is beneficial in younger patients, because men over age 75 have an average life expectancy of about 10 years or less, there would unlikely ever be any mortality benefit from screening older males. On the other hand, screening does result in harms from unwarranted treatment, such as erectile dysfunction, incontinence, and even death. Furthermore, there are harms associated with biopsy, including pain and psychological effects. The task force continues to cite “insufficient evidence” for screening in younger patients, and again continues to suggest that the “uncertain benefits and the known harms” be discussed with all patients younger than 75 prior to ordering the test.