The USPSTF last reviewed the evidence on prostate cancer screening and made recommendations in 2008. In an effort to update these guidelines, the USPSTF conducted an exhaustive review of randomized trials of PSA-based screening, randomized trials and cohort studies of prostatectomy or radiation therapy versus watchful waiting (using changes in symptoms to decide whether treatment is needed), and large observational studies of perioperative harms.[3,12] This review sought to answer four key questions: (1) Does PSA-based screening decrease prostate cancer– specific or all-cause mortality? (2) What are the harms of PSA-based screening for prostate cancer? (3) What are the benefits of treatment of early-stage or screening-detected prostate cancer? and (4) What are the harms of treatment of early-stage or screening detected prostate cancer? See Table 1 , Table 2 , Table 3 , and Table 4 for a summary of the evidence.[13]
The USPSTF concluded that the PSA test was more likely to lead to a substantial risk than to a benefit. The PSA test cannot differentiate between aggressive and nonaggressive cancers, which may result in many men undergoing needless surgery and radiation that expose them to significant side effects. According to the USP-STF, up to 5 men in 1,000 will die within a month of prostate cancer surgery, and approximately 10 to 70 men will experience dangerous complications.[3] At least 200 of every 1,000 men treated with radiation or surgery will experience impotence, urinary incontinence, or bowel dysfunction.[3] The USPSTF considers these to be serious risks, considering that its review found that PSA screening has not been proven to save lives.
