# USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)

Source: https://onco.cc/key-papers/paper-uspstf-prostate-screening-jama-2018/  
OnCo record `paper-uspstf-prostate-screening-jama-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Six years after recommending against PSA testing for everyone, the same body changed its mind for men aged 55 to 69 and said the decision should be theirs. The statement puts the numbers on both sides: about 1.3 deaths prevented per 1,000 men screened, and one in five who have surgery left with long-term incontinence.

## Summary

The United States Preventive Services Task Force updated the 2012 grade D statement after reviewing the trials, commissioning a review of decision-analysis models and commissioning a separate review of the overdiagnosis rate, including in subgroups at higher risk: older men, African American men and men with a family history.

The 2018 statement is unusually useful to read as a patient because it states the benefit and the harm in the same units. Screening men aged 55 to 69 may prevent about 1.3 prostate cancer deaths and about 3 cases of metastatic disease per 1,000 men screened over about 13 years. Against that: about 1 in 5 men who have radical prostatectomy develop long-term urinary incontinence and 2 in 3 experience long-term erectile dysfunction. The task force concluded the net benefit is small for some men and that clinicians should not screen men who do not express a preference for it.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Also known as: USPSTF 2018 prostate; grade C prostate screening; shared decision making prostate screening
- Tags: prostate-evidence
- Journal: JAMA
- Year: 2018
- DOI: 10.1001/jama.2018.3710
- Authors: US Preventive Services Task Force, Grossman DC, Curry SJ, et al.
- Findings: Screening programmes in men aged 55 to 69 may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1,000 men screened.; Screening programmes may also prevent approximately 3 cases of metastatic prostate cancer per 1,000 men screened.; About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 will experience long-term erectile dysfunction.; Grade C for men aged 55 to 69: the decision should be an individual one after discussion of benefits and harms, and clinicians should not screen men who do not express a preference for screening.; Grade D for men aged 70 and over: the potential benefits do not outweigh the expected harms, because of increased risk of false-positive results and diagnostic and treatment harms.; The statement records a lifetime risk of being diagnosed with prostate cancer of approximately 13 percent and of dying of it of 2.5 percent, with a median age at death from prostate cancer of 80 years.
- What it means: The current shape of the screening question in the United States, and the best short statement of the trade-off in numbers a man can weigh. The three-to-one ratio between metastatic cases prevented and deaths prevented is also the argument for using metastatic presentation, not mortality, to judge a screening programme sooner.
- Caveats: A recommendation on prostate-specific antigen-based screening as practised in the trials, which did not include magnetic resonance imaging triage or modern active surveillance.; The harms quoted are the harms of treatment, so they fall on the men who are treated rather than on everyone screened; the size of the harm therefore depends on how many screen-detected cancers are managed conservatively.; Evidence in African American men and men with a family history was reviewed but is thinner than in the general population, and the recommendation does not set separate thresholds for them.

## Sources

- JAMA 2018: https://doi.org/10.1001/jama.2018.3710
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29801017/
- USPSTF: prostate cancer screening: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

## Connected records

- key papers: [Association of Black race with prostate cancer-specific and other-cause mortality](https://onco.cc/key-papers/paper-dess-black-race-prostate-mortality-jama-oncol-2019/), [Overdiagnosis and overtreatment of prostate cancer](https://onco.cc/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/), [ProtecT: fifteen-year outcomes after monitoring, surgery or radiotherapy for prostate cancer](https://onco.cc/key-papers/paper-protect-15-year-nejm-2023/), [USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)](https://onco.cc/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/)
- ideas: [Decision aids built into the record for every preference-sensitive cancer choice](https://onco.cc/ideas/idea-acc-embedded-decision-aids/), [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/), [Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity](https://onco.cc/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/)
- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- cancers: [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- terms: [Metastasis-free survival (MFS)](https://onco.cc/terms/metastasis-free-survival/), [Number needed to screen (and number needed to diagnose)](https://onco.cc/terms/number-needed-to-screen/), [Other-cause mortality](https://onco.cc/terms/other-cause-mortality/), [Overdiagnosis](https://onco.cc/terms/overdiagnosis/), [Overtreatment](https://onco.cc/terms/overtreatment/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Screening](https://onco.cc/terms/screening/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- journals: [JAMA](https://onco.cc/journals/jama/)

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