A Model of Prostate-Specific Antigen Screening Outcomes for Low- to High-Risk Men

Abstract

Prostate-specific antigen (PSA) screening for prostate cancer causes uncertainty and concern for men and their physicians. Findings from 2 large randomized trials^1,2 that were supposed to provide answers and clarity may have worsened the situation. The trials report evidence of benefit but also evidence of substantial harm. Adding to community uncertainty are conflicting recommendations from health authorities and clinical guidelines. For example, the American Cancer Society “believes that health care professionals should discuss the potential benefits and limitations . . . discussion should include an offer for testing with the PSA blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy.”³ The American Urological Association likewise considers that the PSA test is a “valuable screening tool” that “should be appropriately offered to men” 40 years and older.^4,5 In contrast, the US Preventive Services Task Force has assigned an “I” (“insufficient evidence”) rating to PSA screening, noting that PSA screening is “associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient's health.”⁶