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Prostate cancer screening using prostate-specific antigen (PSA) tests offers limited mortality benefits but carries risks. Shared decision-making is crucial for men aged 55-69 to weigh benefits and harms before screening.

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Area of Science:

  • Oncology
  • Urology
  • Preventive Medicine

Background:

  • Prostate cancer is a leading cause of cancer death in US men.
  • Screening with prostate-specific antigen (PSA) testing has potential harms, including false positives and overtreatment.
  • Risk factors include age, family history, and Black race.

Purpose of the Study:

  • To summarize current recommendations and considerations for prostate cancer screening.
  • To highlight the importance of shared decision-making in screening protocols.
  • To outline the diagnostic pathway following an elevated PSA level.

Main Methods:

  • Review of national guidelines for prostate cancer screening.
  • Discussion of prostate-specific antigen (PSA) testing protocols and interpretation.
  • Overview of diagnostic workup and treatment options, including active surveillance.

Main Results:

  • PSA screening may slightly reduce prostate cancer mortality but not all-cause mortality.
  • Screening can lead to significant harms such as overdiagnosis and overtreatment.
  • Active surveillance is a preferred approach for low-risk prostate cancer, improving quality of life.

Conclusions:

  • Shared decision-making is essential before initiating prostate cancer screening for men 55-69.
  • Follow-up testing and advanced diagnostics (e.g., MRI) are recommended after elevated PSA levels.
  • Active surveillance offers comparable survival to curative treatment for low-risk prostate cancer with better quality of life.