Info
PSA screening
- Aim is → to reduce dz-specific morbidity &/or mortality. 3 RCTs: PLCO, ERSPC, CAP. In men 55-69 y may prevent ∼1.3 dz-specific deaths over ∼13 y & 3 cases of metastatic prostate CA per 1,000 men screened (JAMA 2018;319;1901). Note methodologic flaws in screening trials. PSA screening increases detection, small benefit in reducing prostate CA mortality, no benefit in reducing overall mortality. Encourage shared decision making-potential benefits & harms (false positive, overdx, bx, anxiety)
- Digital Rectal Exam (DRE) generally not used as a screening test-warranted if sxs or abnormality
- Society/task force recommendations
- ACS: Discussion of PSA screening, if life expectancy >10 y, starting at ↣ 50 y for avg risk, at ↣ 45 y if Black or 1st-degree relative w/ prostate CA <65 y, or at ↣ 40 y w/ multiple 1st-degree relatives w/ prostate CA <65 y (yearly if PSA ≥2.5 ng/mL, otherwise every 2 y). Informed decision making (CA Cancer J Clin 2010;60:70)
- AUA: Shared decision making for men 55-69 y, w/ option for 2+ y interval for men who decide on PSA screening. Recommends against PSA screening in: Men <40 y, avg risk men 40-54 y, >70 y, or w/ <10-15 y life expectancy (J Urol 2013:190:419, confirmed 2018)
- USPSTF: Shared decision making for men aged 55-69 y (JAMA 2018;319:1901)