The researchers advise clinicians and patients considering PSA based screening to weigh these benefits against the potential short and long term harms of screening, including complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment.
An accompanying practice guideline notes that prostate cancer screening with PSA test has increased the number of men diagnosed with and treated for prostate cancer, but many of these men would never have experienced any symptoms or death from prostate cancer. It makes a weak recommendation against offering systematic PSA screening based on the systematic review.
According to an editorial, neither the US Preventive Services Task Force nor Public Health England recommend population screening as there is little evidence that screening would reduce deaths from prostate cancer, though both countries suggest that decisions about prostate cancer testing should involve discussion with individual patients of the potential benefits and harms of testing. It notes that men will continue to go to their GPs asking for a test, and their experiences vary greatly from GPs who simply offer the test with little discussion to those who decline, advising that the test has little or no value. It suggests that conversations with patients requesting a PSA test should explore their reasons for requesting a test and include evidence based discussions about possible harms and benefits of PSA testing, informed by the patient’s ethnicity and family history, and about recent advances in the use of mp-MRI and active surveillance, which have the potential to reduce the harms of testing.