Prostate-Specific Antigen-Based Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis No. 90

摘要

The American Cancer Society estimates that in 2011, about 241,000 men will be diagnosed with prostate cancer and 34,000 men will die from it, making it the most commonly diagnosed nonskin cancer and the second leading cause of cancer death in men.1 Prostate-specific antigen (PSA)-based screening programs have been advocated as a possible means to reduce the mortality rate, as the test can detect asymptomatic, early-stage tumors. Beginning in the 1990s, utilization of the PSA test became widespread in U.S. clinical practice; data from nationally representative surveys2,3 and community primary care clinics consistently show that the majority of American men aged 50 years and older receive regular PSA tests. In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against screening for prostate cancer in men aged 75 years and older. It concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years, due to a lack of evidence that screening reduced mortality. The subsequent publication of initial mortality results from two large, randomized controlled trials of prostate cancer screening (the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC)) prompted the USPSTF to request an updated systematic evidence review of direct evidence on the benefits and harms of PSA-based screening for prostate cancer. The USPSTF commissioned a separate report examining the benefits and harms of treatment for localized prostate cancer, given that the overall outcomes of early detection are intrinsically tied to the subsequent use of therapies.