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GPs should not screen patients over 70 for prostate cancer, researchers say

GPs should not carry out PSA screening on men aged 70 and over as the harms outweigh any potential benefits, new guidelines from the US have said. 

The guidance, published in the Annals of Internal Medicine by the US Preventive Services Task Force (USPSTF) goes against Public Health England advice to offer the test to ‘any well man aged 50 and over who requests it’.

PHE said the UK National Screening Committee will review these new findings as part of its next recommendations update.

In drawing up the guidance, researchers carried out a systematic review of trials and studies relating to PSA screening in men without symptoms of prostate cancer.

The research concluded that asymptomatic men aged 55 to 69 years should only be screened if they request it, regardless of whether they have an increased risk for prostate cancer death due to race, ethnicity, or a family history of prostate cancer.

It added that PSA screening should not be carried out in men aged 70 years and over.

The researchers wrote: ‘Men (55 to 69 years of age) should not be screened unless they express a preference for it after an opportunity to discuss potential benefits and risks of screening and to incorporate their values and preferences in the decision.

‘In men 70 years of age and over, the USPSTF recommended against PSA screening for prostate cancer.’

The guidelines added that for men aged 70 and over, the recommendation was ‘based on moderate certainty that potential benefits do not outweigh expected harms’.

PHE’s current prostate cancer risk management guidance for asymptomatic men says: ‘The PSA test is available free to any well man aged 50 and over who requests it.’

But PHE’s UK director of programmes Professor Anne Mackie said: ‘The UK’s independent expert screening committee will review the findings of this new international guidance.

‘The committee is currently planning its next update and will consider the results of this research.’

BMA GP Committee clinical and prescribing policy lead Dr Andrew Green told Pulse: ‘It is interesting to note that even in the screening-hungry States the appetite for this test is decreasing.

‘The fact is that PSA testing for men without increased risk fails all the criteria for a valid screening test, producing no increase in survival at great risk of harm through over-diagnosis.’

Researchers previously found that while doing PSA tests on men without symptoms detects disease unlikely to cause harm, it often misses aggressive and lethal prostate cancers.

However, following this study, NICE told Pulse that it has no plans to review its recommendations on digital rectal examinations for prostate cancer.


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