- What are the Task Force’s prostate cancer screening recommendations?
- Why is the Task Force making this recommendation now?
- What’s the difference between this recommendation and the 2012 final recommendation?
How to interpret the recommendations
- What is the PSA test?
- Who do these recommendations apply to?
- Is a C grade a recommendation against screening?
- How often does the Task Force recommend that men have this discussion about screening with their clinician?
- What does the Task Force mean when it refers to men’s “values and preferences”?
- Isn’t early detection and treatment of cancer a good thing?
- What does the science say about prostate cancer treatment?
The benefits and harms of screening
- What’s the latest evidence on the benefits of screening?
- What’s the harm in getting a PSA test?
- What is overdiagnosis and why is it a serious harm?
- What is active surveillance?
Guidance for men at high risk
- How do I know if I’m at high risk for prostate cancer?
- What does the Task Force recommend for men at high risk?
About the 2017 draft recommendations
What are the Task Force’s prostate cancer screening recommendations?
Through its review of the evidence, the Task Force determined that the potential benefits and harms of prostate-specific antigen (PSA)–based screening are closely balanced in men ages 55 to 69, and that the decision about whether to be screened should be an individual one. Clinicians should talk to men ages 55 to 69 about the potential benefits and harms of screening and help them make a decision about screening based on their personal values and preferences. The draft recommendation applies to adult men who have not been previously diagnosed with prostate cancer and have no signs or symptoms of the disease.
This recommendation applies to men who are at high risk for prostate cancer as well, and the Task Force provides additional information to help support these men in making informed decisions about screening. Clinicians should inform African American patients about their increased risk of developing and dying of prostate cancer, as well as the potential benefits and harms of screening. Clinicians should also inform patients with a family history of prostate cancer about their increased risk of developing the disease.
The Task Force does not recommend screening for prostate cancer in men who are older than 70, including African American men and men with a family history of prostate cancer, because the potential harms outweigh the potential benefits.
Why is the Task Force making this recommendation now?
The Task Force routinely updates its recommendations to reflect the latest available science. The Task Force published its last recommendation on screening for prostate cancer in 2012. The Task Force began working on this update in late 2015 and the posting of this draft recommendation statement is on schedule.
What’s the difference between this recommendation and the 2012 final recommendation?
Through this draft recommendation statement, the Task Force continues to provide men and their clinicians with information to help guide decisions about screening. The Task Force continues to find that the potential benefits and harms of screening are closely balanced. To update this recommendation, we looked at new evidence that helps us better understand the potential benefits of prostate cancer screening. We also reviewed new evidence about the potential safety of active surveillance.
Active surveillance has become a more common treatment choice for men with low-risk prostate cancer over the past several years, and may reduce the potential harms of screening in low-risk men who choose this option.
The new evidence and increased use of active surveillance convinced the Task Force to revise its recommendation for men ages 55 to 69. Today, the Task Force recommends that men consider both the potential benefits and harms and make an individual decision about whether to be screened, based on their values and preferences.
The evidence continues to show that the potential benefits do not outweigh the harms of screening in men age 70 and older. The Task Force recommends against screening for prostate cancer in these men.
How to interpret the recommendations
The PSA test measures the amount of prostate-specific antigen, a type of protein, in a man’s blood. When a man has an elevated PSA, it may be caused by prostate cancer, but it could also be caused by other conditions such as an enlarged prostate or an inflammation of the prostate. The PSA test and followup prostate biopsies can’t tell for sure which cancers will likely be aggressive and spread, and which will not—or will grow so slowly that they will never cause symptoms. This means some men will benefit from treating screen-detected prostate cancer, but many more will be treated without benefit.
Until we have better screening tests to distinguish between men who will have high-risk cancer and those who won’t, it’s important for men who are considering screening to understand both the potential benefits and harms.
Who do these recommendations apply to?
These draft recommendations apply to men ages 55 and older who have not been previously diagnosed with prostate cancer and have no signs or symptoms of the disease. These draft recommendations also apply to men who are at increased risk for prostate cancer, including African American men and men with a family history of prostate cancer.
Is a C grade a recommendation against screening?
No, the Task Force is not recommending against screening in men ages 55 to 69. There are real potential benefits, as well as the potential for life-altering harms, among men in this age group. We recommend that the decision about whether to be screened between the ages of 55 and 69 should be an individual one, made after a conversation with a clinician about the potential benefits and harms. For men who are more willing to accept the potential harms, screening may be the right choice. Men who are more interested in avoiding the potential harms may choose not to be screened.
How often does the Task Force recommend that men have this discussion about screening with their clinician?
Our draft recommendations don’t contain specific guidance on how often men should be screened. However, we encourage men to continue to have conversations about screening with their clinician over the years, as their values and preferences about screening may change over time as they age or have other health issues.
We do not recommend that men age 70 and older be screened for prostate cancer because evidence shows that the harms of screening outweigh the benefits for men in this age group.
What does the Task Force mean when they refer to men’s “values and preferences”?
Prostate cancer screening benefits a small number of men and leads to harms for many others. The decision about whether to be screened is therefore complicated, and men who are considering screening deserve to know what the science says so they can make the best choice for themselves, together with their clinician. For men who understand the potential benefits and are willing to accept the potential harms, screening may be the right choice. Men who are more interested in avoiding the potential harms may choose not to be screened.
Isn’t early detection and treatment for cancer a good thing?
We understand that when someone learns they have cancer, there is a strong desire to treat or remove the cancer, regardless of the potential harms of treatment. Prostate cancer can be slow growing and, for many men, will not cause any problems in their lifetime. In these men, active treatment has no potential benefit and puts them at risk for significant harms. Research suggests that 20% to 50% of men diagnosed with prostate cancer after screening may be overdiagnosed (that is, diagnosed with cancer that won’t affect their health during their lifetime).
The discovery of an overdiagnosed cancer can result in overtreatment, including invasive procedures, chemotherapy, and radiation, which can have significant harms. There are also aggressive cancers that do not respond well to current treatments. Treating these cancers early may not alter their course, and the cancer may not cause any problems in a man’s lifetime.
When a cancer is overdiagnosed it can result in overtreatment, which can include invasive procedures, chemotherapy, and radiation, which can have significant harms without any potential for benefit.
What does the science say about prostate cancer treatment?
This draft recommendation statement reflects new evidence about prostate cancer treatment, including the use of active surveillance in men with low-risk prostate cancer. Active surveillance is a way of monitoring prostate cancer that hasn’t spread outside the prostate, rather than treating it immediately with surgery or radiation. Active surveillance has become a more common treatment choice over the past several years, and may reduce the chance of overtreatment or offer men the opportunity to delay active treatment and complications. This surveillance includes regular, repeated PSA testing and often repeated digital rectal examination and prostate biopsy. Men whose cancer progresses during active surveillance are offered surgery or radiation treatment.
The Task Force found that there are a number of harms associated with active treatment, such as sexual impotence and urinary incontinence. These harms occur immediately, whereas the benefits of screening are likely realized years, even more than a decade, after treatment. This is because prostate cancer tends to be slow growing. More than 2 out of 3 men treated for prostate cancer with surgery to remove the prostate gland develop long-term sexual impotence and more than half of men treated with radiation develop long-term sexual impotence.
The benefits and harms of screening
What’s the latest evidence on the benefits of screening?
We reviewed new evidence that helps us better understand the benefits of screening, which include reducing the chance of dying of prostate cancer. Research suggests that for every 1,000 men ages 55 to 69 offered prostate cancer screening with the PSA test, 1 to 2 men may avoid dying of prostate cancer over 10 to 15 years. Another important benefit of screening is reducing the risk of metastatic cancer. Metastatic cancer is the spread of cancer cells to new areas of the body. Studies suggest that for every 1,000 men offered screening, 3 men may avoid metastatic cancer after 10 to 15 years. Because prostate cancer often grows slowly, the benefits of screening are generally realized years, even more than a decade, after diagnosis and treatment.
Studies show that the potential benefits of screening in men older than age 70 do not outweigh the potential harms.
What’s the harm in getting a PSA test?
One of the most important harms of screening and diagnosis of prostate cancer is overdiagnosis; because of the limitations of the PSA test and diagnostic biopsy, screening leads to the diagnosis of prostate cancer in some men who wouldn’t have experienced symptoms during their lifetime. Thus, treatment of these men provides them with no benefit.
Other harms of screening include frequent false-positive results, which often lead to immediate additional testing and years of additional close followup, including repeated blood tests and biopsies. Common harms associated with the active treatment of prostate cancer include sexual impotence and urinary incontinence.
Many more men experience harms from prostate cancer screening, diagnosis, and treatment than experience benefit.
What is overdiagnosis and why is it a serious harm?
Because of the limitations of the PSA test, screening leads to the diagnosis of prostate cancer in some men who would not have experienced symptoms during their lifetime. Thus, treatment of these men provides them with no benefit. This is called “overdiagnosis.” The discovery of an overdiagnosed cancer can result in overtreatment, including invasive procedures, chemotherapy, and radiation, which can have significant harms.
Active surveillance is a way of monitoring prostate cancer that hasn’t spread outside the prostate, rather than treating it immediately with surgery or radiation. Active surveillance has become a more common treatment choice over the past several years among men with low-risk prostate cancer, and may reduce the chance of overtreatment. It includes regular, repeated PSA testing and often repeated digital rectal examination and prostate biopsy. Active surveillance may also offer men with low-risk cancer the opportunity to delay active treatment and complications—or avoid active treatment completely. Men whose cancer progresses during active surveillance are offered surgery or radiation treatment.
Guidance for men at high risk
How do I know if I’m at high risk for prostate cancer?
African American men and men who have a family history of prostate cancer are at increased risk for prostate cancer.
African American men are more likely to develop prostate cancer than white men. They’re also more than twice as likely as white men to die of prostate cancer. This is due in part to African American men having higher rates of more aggressive cancer and the fact that African American men tend to be diagnosed when their cancer is more advanced. The higher rates of death from prostate cancer may also reflect that African American men have lower rates of receiving high-quality care.
Men with a father or brother who has had prostate cancer are also at increased risk for developing the disease. This is particularly important for men whose father or brother have been diagnosed at a younger age or who died from prostate cancer. Men with three first-degree relatives (father, brother, and son) with prostate cancer or two close relatives on the same side of the family with prostate cancer who were diagnosed before age 55 may have an inheritable form of prostate cancer associated with genetic changes that are passed down from one generation to the next.
What does the Task Force recommend for men at high risk?
There is no one correct answer about screening for men who are at increased risk. We encourage African American men to talk to their clinician about their increased risk of developing and dying of prostate cancer, as well as the potential benefits and harms of screening. Men with a family history of prostate cancer should also talk to their clinician about the potential benefits and harms of screening. This is particularly important for men whose father or brother have been previously diagnosed.
Screening offers men at increased risk for developing prostate cancer the potential to prevent death from prostate cancer, but screening also has potential harms. Each man’s personal values and preferences about the benefits and harms of screening should be used to decide if he should be screened for prostate cancer.
The Task Force does not recommend screening for prostate cancer in men who are older than age 70, including African American men and men with a family history of prostate cancer.