The Ever-evolving Status of Prostate Cancer Screening
SOURCE: Bibbins-Domingo K, Grossman DC, Curry SJ. JAMA 2017;317:1949-1950.
The most recent 2017 U.S. Preventive Services Task Force (USPSTF) recommendations regarding prostate cancer screening, which still are open to comment and revision, represent a shift from its “do not screen” statement of 2012. At first glance, the advice may appear to be an “endorsement”; however, one must remember that there are various strengths of endorsement. For instance, the current recommendation boils down to: “Clinicians should inform men aged 55-69 about the potential benefits and harms of screening.” Benefits include about one in 1,000 fewer deaths from prostate cancer and three in 1,000 fewer incidences of metastatic disease when men are followed for 12-13 years. Well-publicized harms include impotence and urinary incontinence.
One’s enthusiasm for the newer, more sanguine recommendations rightly might be damped by noting that this recommendation is graded as “Level C.” What does that mean? In the words of the USPSTF: “The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.”
In other words, each patient must decide whether he is willing to shoulder the risks associated with prostate cancer screening for the possibility that he will be one of the very few men who benefit, which is not an easy call.
Each patient must decide whether he is willing to shoulder the risks associated with prostate cancer screening.
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