The United States Preventive Services Task Force has updated its recommendations for prostate cancer screening. The last time they issued a statement was 2012. They have taken a softer line this time. In 2012 they came out against prostate cancer screening because there were no convincing data showing a decrease in mortality among men screened. Here is what they are saying in the newly guidelines, recently published in the Journal of the American Medical Association. Click here for the article. They have softened their previous recomendations. Now they are saying that for men ages 55-69 they should have a discussion with their physician about risks and benefits of screening. For men over 70 they are still recommending against screening. One could reasonably ask: what made them change their minds other than the public outcry about the prior guidelines? The authors cite a European study that concluded that with screening approximately 1.3 lives could be saved for every thousand men every 13 years. Another 3 men per 1000 could be spared developing metastatic disease, although by this analysis they would die with, rather than of, metastases. The authors continue to stress the massive morbidity created by treating prostate cancer that would never turn into a source of morbidity and mortality: urinary incontinence (one in five men); and erectile dysfunction, usually permanent impotence (two out of three). For men treated with radiation instead of radical prostatectomy, the risk of long-term bowel problems remain as well. Nothing about the technology of prostate cancer treatment has moved these numbers in recent memory.
Dr. Stark weighs in: I have stopped having my PSA checked. These new recommendations don’t change that. I have no special risk factors other than age. In fact the study looks at men with special risk factors and does not alter its recommendations for men at higher risk, presumably because the risks of treatment still massively outweigh the benefits. The big exception (not covered in the article) is men taking testosterone replacement. They can develop an accelerated version of prostate cancer and in my opinion need to be monitored carefully.