Screening for Prostate Cancer

Abstract

Screening for Prostate Cancer Prostate cancer is the most diagnosed cancer (excluding nonmelanoma skin cancer) and is the cancer with the second highest mortality among men in the United States. Prostate cancer-specific survival at 10 years is 95% among men with localized disease. Prostate-specific antigen (PSA) screening should involve shared decision making with consideration of the risks and benefits of screening and patient preferences. Findings from randomized trials support a modest reduction in prostate cancer mortality with PSA screening; screening 1000 men may prevent deaths from prostate cancer in 1.3 men in the 13 years after initial screening. Persons with elevated PSA levels on screening may choose to undergo further tests to inform the need for biopsy, multiparametric magnetic resonance imaging (MRI) to identify biopsy targets, or both. Persons with low-risk or favorable intermediate-risk prostate cancer may choose to undergo active surveillance (periodic PSA tests and biopsies) over immediate curative treatment (surgery or radiation therapy). Surgery and radiation therapy generally provide excellent outcomes in prostate cancer but may result in harms, including urinary incontinence and erectile dysfunction with surgery, and bowel dysfunction and erectile dysfunction with radiation therapy. Screening for Prostate Cancer PSA screening for prostate cancer should involve consideration of benefits and risks. Screening is associated with a small reduction in prostate cancer deaths; risks include overdiagnosis and unnecessary biopsy and treatment.