The U.S. Preventive Services Task Force has put new guidelines for prostate cancer screening out for public comment.

“The USPSTF recommends individualized decision-making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening, and to incorporate his values and preferences into his decision,” it stated.

“Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men ages 55 to 69 years may prevent up to 1 to 2 deaths from prostate cancer over approximately 13 years per 1,000 men screened. Screening programs may also prevent up to 3 cases of metastatic prostate cancer per 1,000 men screened over 13 years,” advised the group.

That said, the USPSTF noted that “the potential benefits and harms of PSA-based screening for prostate cancer in men ages 55 to 69 years are closely balanced. Each man’s individual values and preferences will determine whether he feels that the overall balance of potential benefits and harms is positive or negative.”

A test is still not advisable in men over 70 years of age, it noted, pointing out that, “adequate evidence from randomized clinical trials is consistent with no mortality benefit of PSA-based screening for prostate cancer in men age 70 years and older.”

The issue, of course, is that false positives can lead to overdiagnosis and over-treatment of what is often a slow moving cancer. And treatment can have significant downsides.

“Harms of prostate cancer treatment include sexual impotence, urinary incontinence, and bothersome bowel symptoms. About 1 in 5 men who have a radical prostatectomy develop long-term urinary incontinence requiring diaper use and more than 2 in 3 men experience long-term sexual impotence. More than half of men who have radiation therapy experience long-term sexual impotence and up to 1 in 6 men experience long-term bothersome bowel symptoms, including bowel urgency and fecal incontinence. Adequate evidence suggests that the harms of overdiagnosis and treatment are at least moderate,” the group advised.

The group last set guidelines in 2012. Since that time, the draft notice stated, the results from new studies, combined with the fact that physicians are more likely now to treat positive screenings with less aggressive therapeutic approaches, have contributed to rethinking testing in a younger group of men.

“This new evidence led the task force to conclude that there is now a small net benefit to screening, although we continue to note that the balance of benefits to harms is close,” task force chair Dr. Kirsten Bibbins-Domingo, a researcher at the University of California, San Francisco, told Reuters.

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