A Brief Synopsis of AFP's Article "Screening for Prostate Cancer: Recommendation Statement"

A brief review of:
Screening for Prostate Cancer: Recommendation Statement                                    
Am Fam Physician. 2013 Feb 15;87(4):
http://www.aafp.org/afp/2013/0215/od1.html


    According to the USPSTF, PSA testing is not recommended. The main goal of testing is to find patients that would benefit from treatment and decrease morbitiy and mortality. Most cases of prostate cancer have a good prognosis without treatment. Many patients will have a tumor that will progress slowly or remain asymptomatic. Most patients who do die of prostate cancer are older than 75 years old.  
     Patients are overdiagnosed due to the screening up to 50% of the time. Depending on the cutoff values, there could be a false positive rate of up to 80%! This can lead to many unnecessary biopsies. According to this article, prostate cancer may be found on biopsy of up to 25% of men regardless of PSA value. Up to 33% of patients can have adverse reactions to the biopsy, including pain, fever, bleeding, infection, and urinary problems.
     If the patient decides on treatment, there are more issues.  Up to 5 patients in 1000 will die within one month of having surgery and up to another 70 will have serious complications. If the patients gets surgery and radiotherapy, up to 300 out of 1000 will have urinary incontinence and erectile dysfunction.  It has been shown that watchful waiting had the same morbidity as aggressive treatment.
   The bottom line is that the benefits do not outweigh the risks.