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In 2012 the American preventive services body recommended against PSA screening for every man at every age. It is the most consequential negative screening recommendation ever made, and it was reversed six years later.
The United States Preventive Services Task Force, reporting through Virginia Moyer, updated its 2008 statement after reviewing the evidence on the benefits and harms of prostate-specific antigen screening and of treating screen-detected localised disease. The recommendation was grade D: recommend against, for men in the general United States population regardless of age.
The statement was made in the light of PLCO, which had found no mortality benefit, and ERSPC, which had found a small one at a high cost in overdiagnosis. Prostate-specific antigen testing and prostate biopsy rates fell in the United States afterwards, and so, over the following years, did the proportion of cancers diagnosed at a localised stage. The 2018 update (paper-uspstf-prostate-screening-jama-2018) moved men aged 55 to 69 to grade C, shared decision-making, and left men aged 70 and over at grade D.
The clearest case in cancer screening of a national body acting on the harms rather than the headline. Whether it was right is still argued: testing and localised-stage diagnosis fell, and the long-term effect on metastatic presentation and mortality is the subject of the studies that followed.
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.
The trial that made prostate screening contested in the United States, and the reason the 2012 task force recommended against it. Its main lesson is methodological: a screening trial whose control group screens itself cannot measure the effect of screening.
Shares PLCO: mortality results from a randomised prostate cancer screening trial, Lead time, and lead-time bias, ERSPC: screening and prostate cancer mortality in a randomised European study, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Lead time, and lead-time bias, ERSPC: screening and prostate cancer mortality in a randomised European study, Overtreatment, Overdiagnosis and the tag prostate-evidence.
Shares Lead time, and lead-time bias, USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Overtreatment, Overdiagnosis and the tag prostate-evidence.
Shares Lead time, and lead-time bias, Overtreatment, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Lead time, and lead-time bias, ERSPC: screening and prostate cancer mortality in a randomised European study, USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Overtreatment and the tag prostate-evidence.
Shares Overtreatment, Overdiagnosis, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Overdiagnosis and false alarms, 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 and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening, Overdiagnosis and false alarms and the tag prostate-evidence.