The US Preventive Services Task Force (USPSTF) analyzed the benefits and harms of prostate specific antigen (PSA)-based screening for prostate cancer (PCa). The Grade ‘D' recommendation of the USPSTF was based mainly on the Prostate, Lung, Colorectal, and Ovarian (PLCO) study in the United States. That result showed only a small reduction in PCa mortality. However, the data from the International Agency for Research on Cancer (IARC) illustrated the PCa mortality rate (MR) decreased marked. To avoid the over-diagnosis and over-treatment, the American Cancer Society has changed its strategy and updated its guidance. The USPSTF neglected the aggressive PCa accounted for more then 30% of all PCa. Highly aggressive PCa can be diagnosed by PSA screening combined with Gleason grade. We hope that the USPSTF changes the ‘D' recommendation for PSA screening.
The US Preventive Services Task Force (USPSTF) analyzed the benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer (PCa)1,2,3 and gave it ‘D' recommendation that meant they recommended against PSA-based screening for PCa in all age groups for updated data in 2012.3 In that paper, the USPSTF emphasized the good prognosis of most patients with PCa; however, they neglected the aggressive PCa (Gleason grade 4/5) that account for more than 30% of all PCa patients.4 Additionally, the task force stated that PSA screening did not reduce the mortality rate (MR) of PCa,5 whereas the data from the International Agency for Research on Cancer (IARC) indicated that both the incidence rate (IR) and MR were significantly reduced.6,7 Although we mostly agree with the task force's analysis, we have some conflicting opinions on this issue.