Tailor prostate screening based on life expectancy, ASCO recommends

A provisional clinical opinion from the American Society of Clinical Oncology (ASCO) recommends against prostate-specific antigen (PSA) screening for men with a life expectancy of 10 years or less.

The provisional opinion recommends a discussion between physicians and patients about the appropriateness of PSA screening. The opinion was published online July 16 by the Journal of Clinical Oncology.

The experts based their recommendations on a 2011 Agency for Healthcare Research and Quality systematic review. Results were driven primarily by the two largest randomized, controlled trials in the analysis, both with evidence rated as fair quality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and 11-year follow-up results for the European Randomized Study of Screening for Prostate Cancer.

The recommendations are as follows:

• In men with a life expectancy of 10 years or less, general screening for prostate cancer with PSA should be discouraged, because harms seem to outweigh potential benefits.
• In men with a life expectancy greater than 10 years, physicians should discuss whether PSA testing for prostate cancer screening is appropriate, based on consideration of complications from unnecessary biopsy, surgery or radiation treatment.

“Screening with PSA may identify prostate cancers earlier, but better screening approaches are needed, such as risk stratification for screening and assessing individualized risk for prostate cancer,” the authors wrote. “It is well established that a patient's age and level of comorbidity need to be considered when deciding whether to screen for prostate cancer.”

This recommendation differs from that of the U.S. Preventive Services Task Force, which recently recommended against using the test for prostate cancer screening in men of all ages in the general population.