Sigrid V. Carlsson, MD, PhD, MPH, presented “The USPSTF Prostate Cancer Screening Recommendation: A Swinging Pendulum” during the 27th Annual Perspectives in Urology: Point Counterpoint on November 9, 2018 in Scottsdale, Arizona.

How to cite: Carlsson, Sigrid V. “The USPSTF Prostate Cancer Screening Recommendation: A Swinging Pendulum” November 9, 2018. Accessed Jul 2024.

The USPSTF Prostate Cancer Screening Recommendation: A Swinging Pendulum – Summary:

Sigrid V. Carlsson, MD, PhD, MPH, reviews the history of PSA screening, from its discovery to the controversy related to United States Preventive Services Task Force (USPSTF) gradings during the current era. She also assesses the harms and benefits of PSA screening and responsible application of the PSA test.


Randomized controlled trials, such as the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Göteborg-1 trial, have unequivocally shown that regular prostate specific antigen (PSA) screening of men ages 50-70 reduces the risk of metastatic disease and death from prostate cancer.

Unfortunately, such screenings may lead to anxiety, false positives, unnecessary prostate biopsies, complications from biopsy, overdiagnosis, and side-effects from treatment.

This presentation reviews the historical journey of PSA screening. It outlines the past use of PSA screening, from the discovery of the PSA test during the 1980s to its dissemination between that time and 2007. In the present era (2008-2019), randomized screening trials demonstrate benefits to PSA screening, but the USPSTF guidelines have changed like a swinging pendulum. The USPSTF then updated its 2008 grade for PSA, “I” for insufficient evidence, to “D”, for recommending against PSA, in 2012. Through changes in PSA usage, biopsy, and incidence patterns, the grade shifted to “C” in 2018, for recommending shared decision-making. In the future, risk-stratified screening could be the solution for mitigating the harms of PSA screening without losing its benefits.

Further Information about USPSTF Guidelines on PSA Screening:

The Evolution of Understanding the USPSTF: Recommendations and Controversy” by Neal D. Shore, MD

Impact of the USPSTF Recommendations on Screening” by Gerald L. Andriole, Jr., MD

Prostate Cancer Early Diagnosis Screening” by Guilherme Godoy, MD, MPH

Updates on the ERSPC and the PLCO Trials” by Gerald L. Andriole, Jr., MD

Prostate Cancer Screening: Who? Why? How?”  by Gerald L. Andriole, Jr., MD

About Perspectives in Urology: Point Counterpoint

Perspectives in Urology: Point Counterpoint (PCP) is an annual CME-accredited conference devoted to discussing and debating the latest topics in men’s health, general urology, and genitourinary cancers. The conference’s format includes more than didactic lectures. It also includes debates, point-counterpoint discussion panels, and unique case-based presentations. Dr. Carlsson presented this lecture during the 27th PCP in 2018. Please visit this page in order to register for future PCP meetings.


Sigrid V. Carlsson, MD, PhD, MPH, is Director of Clinical Research at Memorial Sloan Kettering Cancer Center’s (MSKCC) Josie Robertson Surgery Center and Assistant Attending Epidemiologist, with dual appointments in MSKCC’s Departments of Surgery (Urology Service) and Epidemiology and Biostatistics. Her line of research focuses on screening and early detection of prostate cancer, including multiplex testing and risk-stratified strategies that incorporate clinical information, biomarkers and magnetic resonance imaging, as recently funded by an NIH/NCI U01 award (PI: Carlsson).

Dr. Carlsson also serves as Associate Professor of Experimental Urology affiliated with the Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, in Sweden, where she is an investigator of two large randomized controlled trials of prostate cancer screening (GOTEBORG-1&2), as recently published in the New England Journal of Medicine (Hugosson J, et al. N Engl J Med 2022). In addition, Dr. Carlsson is Adjunct Senior Lecturer in the Department of Translational Medicine in the Division of Urological Cancers in the Medical Faculty at Lund University, Lund, Sweden.

Dr. Carlsson recently completed a K22 career development award from the NIH/NCI to improve shared decision-making for breast and prostate cancer screening. She serves on the National Comprehensive Cancer Network (NCCN) and is a panel member for the American Urological Association (AUA) guidelines for early detection of prostate cancer. Before pursuing postdoctoral studies in urologic oncology at MSKCC, Dr. Carlsson was a physician in Sweden. She earned her MD and PhD from Gothenburg University in Sweden and earned an MPH from Harvard TH Chan School of Public Health in Boston, Massachusetts.