March 8, 2009

U.S. Preventive Services Task Force Does Not Recommend PSA Screening in Elderly Men


U.S. Preventive Services Task Force Does Not Recommend PSA Screening in Elderly Men

Members of the U.S. Preventive Services Task Force have concluded that there is still insufficient evidence to recommend PSA screening in men 75 years of age or younger. The details of these recommendations were published in the August 5, 2008 issue of the Annals of Internal Medicine.

The prostate is a walnut-size gland located between the bladder and rectum in men that is responsible for the formation of a portion of semen. Cancer of the prostate is a common malignancy among men in the United States, and testing for prostate cancer after the age of 50 is becoming a routine practice. Testing for prostate cancer involves prostate specific antigen (PSA) testing; PSAs are proteins that are normally shed by the prostate into the bloodstream. Elevated levels of PSA can be indicative of the presence of cancer, as well as other non-cancerous (benign) conditions of the prostate.

Considerable debate has ensued regarding the optimal screening schedules for prostate cancer, including which PSA level warrants a prostate biopsy (removal of tissue from the prostate) to detect prostate cancer. As well, the correlation between survival and PSA testing for men who do not have additional risks of developing prostate cancer remains inconclusive, and researchers continue to evaluate data to understand the potential benefits and risks of PSA screening among subgroups of men. The last recommendations by the U.S. Preventive Services Task Force were in 2002. They concluded that there was insufficient evidence to recommend for or against PSA screening in men at average risk for developing prostate cancer.

Researchers affiliated with the U.S. Preventive Services Task Force recently reviewed literature published between 2002 and 2007 regarding PSA screening. According to the data, the task force concluded that “no good-quality randomized, controlled trials of screening for prostate cancer have been completed.” In addition, two studies suggested that false-positive PSA screening results (results suggesting prostate cancer exists when it actually does not) caused “psychological adverse effects for up to 1 year.”

Review of the data revealed that the “natural history of PSA-detected prostate cancer is poorly understood” and that “prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.”

Thus, the U.S. Preventive Services Task Force recommended no routine PSA testing for men over the age of 75 years who were not at an increased risk for prostate cancer. They did not make a recommendation, however, for men 75 years or younger in regards to routine PSA testing: it is important that men speak with their healthcare provider regarding their individual risks and benefits of PSA testing.

Reference: U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2008;149:185-191.

Related News: PSA Screening Overused in Elderly Men in Poor Health (11/17/2006)

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