What you need to know about prostate cancer screening guidelines

William G. Nelson, M.D., Ph.D.

Prostate-specific antigen (PSA)-based screening for prostate cancer has received mixed reviews from different organizations, says William G. Nelson, M.D., Ph.D., director of the Johns Hopkins Kimmel Cancer Center. Today, the United States Preventive Services Task Force has posted draft recommendations for prostate screening that encourage men ages 55 - 69 to make individual decisions about screening after talking with their doctors about potential harms and benefits.

Other organizations recommend that PSA-based screening should be offered to all men beginning at age 50-55; that PSA-based screening should be considered before age 50 for African-American men and for men with a strong family history of prostate cancer; and that all men at risk for prostate cancer should participate in shared decision-making with physicians to ensure that the benefits and harms of screening are well understood before pursuing PSA testing.

“Prostate cancer screening has become somewhat controversial in our society even though it works,” says Nelson. “The controversy stems from the belief that the reduction in prostate cancer deaths due to screening, although real, is small. Some also worry that the harms associated with the diagnosis and treatment of the cancers being detected are common, persistent and may actually be a hazard. They worry that the more men they screen, the harms will increase and the benefits won’t be as fully realized. So they conclude that the benefits don’t outweigh the harms."

“There are screening recommendations from many organizations. Almost all of them come down to the notion that screening can be effective, but there should be serious consideration of the risks and benefits for each individual through a discussion with their doctor and shared decision making to ensure that all the benefits and harms of screening are well understood before pursuing PSA testing or a screening strategy.”

"The increasing use of active surveillance, where many men with low- or very low-risk prostate cancers can avoid treatment and its side effects altogether, may reduce the potential harms of prostate cancer screening at a population scale.”