SOURCE: Wilt TJ, et al. N Engl J Med 2017;377:132-142.
The saga of recommendations about screening for prostate cancer continues to evolve. Whereas in 2012, the U.S. Preventive Services Task Force (USPSTF) gave a “two thumbs down” rating to prostate cancer screening, its 2017 position has softened. Although the strength of the recommendation is only level C (at least moderate certainty that net benefit is small), the USPSTF has indicated that for men 55-69 years of age, clinicians should provide an individualized approach after informing the patient about the risks and benefits. For men ≥ 70 years of age, the USPSTF does not recommend screening.
It’s not clear whether you will find results of a very long-term 2017 prostate cancer follow-up study consonant with the USPSTF recommendations. Wilt et al reported on the 20-year follow-up of men with early prostate cancer treated with surgery or observation. As was noted on the first outcomes report of this same population in 2012, no clear advantage for surgery emerged. That is, neither all-cause mortality nor prostate cancer-related mortality was statistically significantly lower in men who underwent surgical intervention than in men who were randomized to observation.
Since there were many more burdensome adverse effects associated with surgical intervention (primarily erectile dysfunction and urinary incontinence), the choice of treatment does not seem unclear to me were I suffering early prostate cancer, and especially low Gleason score disease. Nonetheless, keeping in step with the USPSTF, clinicians are now encouraged to inform men 55-69 years of age about the relative risks and benefits of screening, and to individualize based on their informed decision.