Would You Recommend Prostate-Specific Antigen Screening for This Patient? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Prostate cancer is the third most common cancer type in the United States overall, accounting for 9.5% of new cancer cases and 5% of cancer deaths. The goal of prostate-specific antigen (PSA)-based screening is to identify early-stage disease that can be treated successfully. The U.S. Preventive Services Task Force (USPSTF) reviewed evidence on the benefits and harms of PSA-based screening and treatment of screen-detected prostate cancer. It found that PSA-based screening in men aged 55 to 69 years prevents approximately 1.3 deaths from prostate cancer over 13 years per 1000 men screened and 3 cases of metastatic cancer per 1000 men screened, with no reduction in all-cause mortality. No benefit was found for PSA-based screening in men aged 70 years and older. On the basis of its review, the USPSTF concluded that the decision for men aged 55 to 69 years to have PSA-based screening should be an individual one and should include a discussion of the potential benefits and harms. Here, 2 experts-an internist and a urologist-discuss the key points of a shared decision-making conversation about PSA-based prostate cancer screening, the PSA-based screening strategy that optimizes benefit and minimizes harm, and the PSA threshold at which they would recommend further diagnostic testing.