Implications of the New USPSTF Prostate Cancer Screening Recommendation—Attaining Equipoise

In abandoning its 2012 objection to prostate-specific antigen (PSA)–based screening for prostate cancer (D recommendation),¹ the US Preventive Services Task Force (USPSTF) now supports individualized decision making for men aged 55 to 69 years (C recommendation).² The new Task Force recommendation, supported by an evidence report and systematic review,³ now aligns the USPSTF with the American Cancer Society⁴ and the American Urological Association.⁵ The USPSTF recommendations, which have consistently been evidence based, appear to have a large influence on practice patterns. Following the 2008 recommendation against screening men older than 75 years,⁶ prostate cancer screening and cancer incidence rates markedly declined for older men.⁷ In the year following the 2011 release of a draft recommendation against any screening (D recommendation; final version published in May 2012¹), the number of men diagnosed with prostate cancer decreased by over 33 000.⁷ Prostate cancer screening rates also subsequently decreased among all age groups by 2013.⁷ The new C recommendation² may well be associated with a resurgence in prostate cancer screening and increased numbers of prostate cancer cases diagnosed, especially if the new guidelines are misunderstood to be endorsing screening rather than offering a more nuanced message about decision making.