The updated statement recommends "individualized decision making" for men ages 55 to 69 after discussing the potential benefits and harms with their physicians. Reactions across the country have been mixed, but one thing is clear: This is going to add to the ongoing controversy and confusion around who should receive the test and when they should receive it.
Why did the USPSTF change its mind?
In 2012, the USPSTF recommended against PSA screening for all men, prompting strong backlash from many professional organizations. Despite that, PSA screening rates (and, subsequently, prostate cancer incidence rates) have declined, indicating that at least some clinicians followed the guidance.
Since 2012, researchers have published additional evidence that has increased the USPSTF's confidence in the benefits of PSA testing. Specifically, the new draft recommendation references a trial that found PSA-based screening may prevent up to 2 deaths and up to 3 cases of metastatic disease per 1,000 men screened over 13 years.
What are the harms of PSA testing?
Although there may be a small net benefit to screening, the USPSTF recognizes that the balance of benefits to harms is extremely close, so the decision to screen should be an individual one.
Specifically, PSA screening can lead to overdiagnosis of slow-growing, low-risk tumors, resulting in increased patient anxiety, aggressive and unnecessary treatment, and high avoidable costs.