Reminder About PSA-Based Screening in Older Men

The goal of prostate cancer screening is to identify the high-risk, localized disease that can be successfully treated. Doing so can prevent the morbidity and mortality associated with advanced or metastatic prostate cancer in asymptomatic men.

The prostate-specific antigen (PSA) screening test is the most common method used to screen for prostate cancer. Whether to perform the test is one of the most important issues in men’s health. And it’s one of the most controversial.

The controversy is over the widespread use of the PSA test to screen for prostate cancer in men who are free of signs and symptoms of the disease.

PSA screening cannot diagnose cancer. A biopsy is necessary to tell the difference between slow growing, harmless prostate cancer and less common, aggressive, and potentially deadly tumors. 

In the United States, about one in nine men will be diagnosed with prostate cancer in their lifetime. And this year, nearly 165,000 men will be diagnosed with prostate cancer.

The harm of PSA-based screening includes:

• False-positive results
• Complications from prostate biopsies
• Over-diagnosis (in 20% to 50% of cases)
• Psychological harm

 
The harm of treatment includes:

• Urinary/fecal incontinence
• Erectile dysfunction
• Pain
• Fever
• Hematospermia

On May 8, 2018, the United States Preventive Services Task Force (USPSTF) released its final recommendation statements for PSA-based screening specifically in older men:

• Grade C – with moderate certainty that net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small.
• Grade D – with moderate certainty that potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harm.

The American Urological Association and the American Cancer Society recommend shared decision-making between patient and physician before prostate cancer screening is ordered. Men should address their concerns and priorities with their doctors to facilitate informed decisions about prostate cancer screening and improve patient satisfaction and outcomes.

It is beneficial for health systems to ensure that providers and their communities understand the risks and benefits of PSA screening. Organizations can develop screening guidelines that align with their communities’ needs and providers’ preferences. It is important to provide decision-support tools for providers and patients to guide informed decision making.

Coverage for PSA screening varies among Highmark’s benefit plans. Please use NaviNet or the applicable HIPAA electronic transactions to check member benefits and eligibility. Also, visit our online Provider Resource Center to view the age-appropriate Highmark Preventive Health Guidelines for screening recommendations. (On the Resource Center, choose Education/Manuals and Clinical Practice and Preventive Health Guidelines.)

If your patients who are Highmark members have questions about coverage, please direct them to call the Member Service number on the back of their Highmark ID card to verify coverage.

Sources:
American Urological Association:  auanet.org/guidelines/early-detection-of-prostate-cancer-(2013-reviewed-and-validity-confirmed-2015
American Cancer Society: cancer.org/cancer/prostate-cancer/early-detection/acs-recommendations.html
Urology Care Foundation: urologyhealth.org