I’d last posted on this subject about a year and a half ago, in the summer of 2016. Since then, there have been a few small changes in the world of prostate cancer screening and the PSA test that I thought I should update you about.
At that point in time, there were seven major medical associations who had published opinions on PSA testing:
This past spring, the USPSTF announced a revision to their guidelines. They’ve proposed a recommendation to discuss pros and cons of PSA testing with men ages 55-69. This change is significant in part because the USPSTF was the first group to suggest not doing PSA testing, and that led to major changes in how we screened for prostate cancer in the past five years. Furthermore, it shifted the majority of opinions in favor of offering testing and educating patients regarding its pros and cons.
How will this change the conversation you have with your doctor at your next appointment? At Atrius Health, we’ve been using our electronic medical record to help monitor our PSA testing. Your doctor likely will want to discuss with you not just whether you’d want your PSA checked, but also how often to check it.
The “how often” continues to be a source of debate. In the Prostate, Lung, Colon, and Ovarian Cancer Screening Trial, or PLCO, annual PSA testing showed no mortality benefit compared to “opportunistic” testing. In the European Randomized Study of Screening for Prostate Cancer Trial, or ERSPC, however, has concluded that testing every two to five years, with an average of every four years, led to a 20% reduction in death from prostate cancer. Men accustomed to having a PSA done yearly might be surprised to know that some groups, such as the AUA, explicitly advise against annual screening with PSA.
At Atrius Health, we often suggest an every-two-year or every-four-year interval to maximize benefits – you can’t realize a 20% mortality benefit without being tested – while minimizing the rates of over-diagnosis. In those with a personal history of prostate cancer or who are being followed for an elevated PSA, we might suggest a more frequent follow-up interval.
PSA testing continues to evolve. Ten years ago, many of us would not have given a second thought to the benefits of screening with PSA. Five years ago, many of us would have stated that we should not screen due to benefits being outweighed by risks. Presently, we’re trying to strike a harmonious balance between these two extremes to best improve outcomes for our patients. Speak with your primary care provider or urologist about the ideal approach for you.