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In the ERSPC trial, the results suggest that, overall, the number needed to screen is 781 men aged 55 to 69 years at enrollment (95% CI, 490-1929) to prevent 1 man from dying of prostate cancer after 13 years. The results varied across the individual ERSPC sites, and prostate cancer mortality was significantly reduced only at the sites in the Netherlands and Sweden. However, point estimates were in favor of screening at all sites except Switzerland. At the largest site (Finland), there was no significant benefit observed for prostate cancer mortality (rate ratio, 0.91 [95% CI, 0.75-1.10]), and in Sweden there was an absolute risk reduction of 0.72% (95% CI, 0.50%-0.94%), a 42% relative reduction.8-10
Based on the available evidence, the USPSTF is not able to make a separate, specific recommendation on PSA-based screening for prostate cancer in men with a family history of prostate cancer. Although it is possible that screening may offer additional potential benefits for these men compared with the general population, screening also has the potential to increase exposure to potential harms, especially among men with relatives whose cancer was overdiagnosed. Men who have a first-degree relative who had advanced prostate cancer at diagnosis, developed metastatic prostate cancer, or died of prostate cancer are probably the most likely to benefit from screening. The USPSTF believes that a reasonable approach for clinicians is to inform men with a family history of prostate cancer, particularly those with multiple first-degree relatives with prostate cancer, about their increased risk of developing cancer as well as the potential earlier age at disease onset. This discussion should include the potential benefits and harms of screening for prostate cancer so these men have the opportunity to make an informed, personal decision about whether to be screened. Although the USPSTF found inadequate evidence about how benefits may differ for men with a family history of prostate cancer, it recognizes the epidemiologic data showing that these men are at a greater than average risk and understands that some men and their clinicians will continue to screen at younger ages in men with a family history. The USPSTF does not recommend screening for prostate cancer in men, including men with a family history of prostate cancer, older than 70 years. 2b1af7f3a8