OWN - NLM
LR - 20180607
IS - 1538-3598 (Electronic)
IS - 0098-7484 (Linking)
VI - 319
IP - 18
DP - 2018 May 8
TI - Screening for Prostate Cancer: US Preventive Services Task Force Recommendation
PG - 1901-1913
LID - 10.1001/jama.2018.3710 [doi]
AB - Importance: In the United States, the lifetime risk of being diagnosed with
prostate cancer is approximately 13%, and the lifetime risk of dying of prostate
cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many
men with prostate cancer never experience symptoms and, without screening, would
never know they have the disease. African American men and men with a family
history of prostate cancer have an increased risk of prostate cancer compared
with other men. Objective: To update the 2012 US Preventive Services Task Force
(USPSTF) recommendation on prostate-specific antigen (PSA)-based screening for
prostate cancer. Evidence Review: The USPSTF reviewed the evidence on the
benefits and harms of PSA-based screening for prostate cancer and subsequent
treatment of screen-detected prostate cancer. The USPSTF also commissioned a
review of existing decision analysis models and the overdiagnosis rate of
PSA-based screening. The reviews also examined the benefits and harms of
PSA-based screening in patient subpopulations at higher risk of prostate cancer,
including older men, African American men, and men with a family history of
prostate cancer. Findings: Adequate evidence from randomized clinical trials
shows that PSA-based screening programs in men aged 55 to 69 years may prevent
approximately 1.3 deaths from prostate cancer over approximately 13 years per
1000 men screened. Screening programs may also prevent approximately 3 cases of
metastatic prostate cancer per 1000 men screened. Potential harms of screening
include frequent false-positive results and psychological harms. Harms of
prostate cancer treatment include erectile dysfunction, urinary incontinence, and
bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop
long-term urinary incontinence, and 2 in 3 men will experience long-term erectile
dysfunction. Adequate evidence shows that the harms of screening in men older
than 70 years are at least moderate and greater than in younger men because of
increased risk of false-positive results, diagnostic harms from biopsies, and
harms from treatment. The USPSTF concludes with moderate certainty that the net
benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is
small for some men. How each man weighs specific benefits and harms will
determine whether the overall net benefit is small. The USPSTF concludes with
moderate certainty that the potential benefits of PSA-based screening for
prostate cancer in men 70 years and older do not outweigh the expected harms.
Conclusions and Recommendation: For men aged 55 to 69 years, the decision to
undergo periodic PSA-based screening for prostate cancer should be an individual
one and should include discussion of the potential benefits and harms of
screening with their clinician. Screening offers a small potential benefit of
reducing the chance of death from prostate cancer in some men. However, many men
will experience potential harms of screening, including false-positive results
that require additional testing and possible prostate biopsy; overdiagnosis and
overtreatment; and treatment complications, such as incontinence and erectile
dysfunction. In determining whether this service is appropriate in individual
cases, patients and clinicians should consider the balance of benefits and harms
on the basis of family history, race/ethnicity, comorbid medical conditions,
patient values about the benefits and harms of screening and treatment-specific
outcomes, and other health needs. Clinicians should not screen men who do not
express a preference for screening. (C recommendation) The USPSTF recommends
against PSA-based screening for prostate cancer in men 70 years and older. (D
CN - US Preventive Services Task Force
FAU - Grossman, David C
AU - Grossman DC
AD - Kaiser Permanente Washington Health Research Institute, Seattle.
FAU - Curry, Susan J
AU - Curry SJ
AD - University of Iowa, Iowa City.
FAU - Owens, Douglas K
AU - Owens DK
AD - Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
AD - Stanford University, Stanford, California.
FAU - Bibbins-Domingo, Kirsten
AU - Bibbins-Domingo K
AD - University of California, San Francisco.
FAU - Caughey, Aaron B
AU - Caughey AB
AD - Oregon Health & Science University, Portland.
FAU - Davidson, Karina W
AU - Davidson KW
AD - Columbia University, New York, New York.
FAU - Doubeni, Chyke A
AU - Doubeni CA
AD - University of Pennsylvania, Philadelphia.
FAU - Ebell, Mark
AU - Ebell M
AD - University of Georgia, Athens.
FAU - Epling, John W Jr
AU - Epling JW Jr
AD - Virginia Tech Carilion School of Medicine, Roanoke.
FAU - Kemper, Alex R
AU - Kemper AR
AD - Nationwide Children's Hospital, Columbus, Ohio.
FAU - Krist, Alex H
AU - Krist AH
AD - Fairfax Family Practice Residency, Fairfax, Virginia.
AD - Virginia Commonwealth University, Richmond.
FAU - Kubik, Martha
AU - Kubik M
AD - Temple University, Philadelphia, Pennsylvania.
FAU - Landefeld, C Seth
AU - Landefeld CS
AD - University of Alabama at Birmingham.
FAU - Mangione, Carol M
AU - Mangione CM
AD - University of California, Los Angeles.
FAU - Silverstein, Michael
AU - Silverstein M
AD - Boston University, Boston, Massachusetts.
FAU - Simon, Melissa A
AU - Simon MA
AD - Northwestern University, Evanston, Illinois.
FAU - Siu, Albert L
AU - Siu AL
AD - Icahn School of Medicine at Mount Sinai, New York, New York.
AD - James J. Peters Veterans Affairs Medical Center, Bronx, New York.
FAU - Tseng, Chien-Wen
AU - Tseng CW
AD - University of Hawaii, Honolulu.
AD - Pacific Health Research and Education Institute, Honolulu, Hawaii.
LA - eng
PT - Journal Article
PT - Practice Guideline
PT - Research Support, U.S. Gov't, Non-P.H.S.
PL - United States
TA - JAMA
JT - JAMA
JID - 7501160
RN - EC 184.108.40.206 (Prostate-Specific Antigen)
SB - AIM
SB - IM
CIN - JAMA. 2018 May 8;319(18):1866-1868. PMID: 29800999
SPIN- JAMA. 2018 May 8;319(18):1946. PMID: 29801013
MH - Age Factors
MH - Aged
MH - Early Detection of Cancer/adverse effects/methods/*standards
MH - False Positive Reactions
MH - Humans
MH - Male
MH - Middle Aged
MH - Prostate-Specific Antigen/*blood
MH - Prostatic Neoplasms/*diagnosis/therapy
MH - Risk Assessment
MH - Risk Factors
EDAT- 2018/05/26 06:00
MHDA- 2018/06/08 06:00
CRDT- 2018/05/26 06:00
PHST- 2018/05/26 06:00 [entrez]
PHST- 2018/05/26 06:00 [pubmed]
PHST- 2018/06/08 06:00 [medline]
AID - 2680553 [pii]
AID - 10.1001/jama.2018.3710 [doi]
PST - ppublish
SO - JAMA. 2018 May 8;319(18):1901-1913. doi: 10.1001/jama.2018.3710.