Breaking News: USPSTF Issues New Prostate Cancer Screening Guidelines

August 5, 2008

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.

3 Responses to Breaking News: USPSTF Issues New Prostate Cancer Screening Guidelines

  1. Ira Breite, MD on August 12, 2008 at 8:56 am

    Great in theory, lousy in practice. I have already heard of one patient (age 82 with multiple problems) who left a practice because his PCP told him he shouldn’t get a PSA. Unless Medicare refuses to pay for it, people will still want it. I am not sure that the PSA will go away even if the two randomized trials out there show no convincing benefit. The fact that a residency program in Virginia was held liable for not getting a PSA on someone, despite appropriate documentation, etc. is not going to help change any practices anytime soon.

    http://www.hi.is/nam/heiml/tulkun.pdf (this is a link to the article in JAMA: JAMA; Jan 7, 2004; 291, 1

  2. Kwame Yeboah on September 3, 2008 at 1:09 pm

    Finally some good news for John McCain; He will be the only president whose annual exams will exclude prostate screening.

    Jokes aside, this is good policy. If I am 75 years old and I have a multitude of ailments, the last thing I want to worry about is a bad prostate.

  3. [...] on the heels of its recommendation in August against routine screening for prostate cancer in men over 75, the US Preventive Services Task Force has issued recommendations against routine screening for [...]

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