American Cancer Society Guideline for the Early Detection of Prostate Cancer: Update 2010

Abstract

In 2009, the American Cancer Society (ACS) Prostate Cancer Advisory Committee began the process of a complete update of recommendations for early prostate cancer detection. A series of systematic evidence reviews was conducted focusing on evidence related to the early detection of prostate cancer, test performance, harms of therapy for localized prostate cancer, and shared and informed decision making in prostate cancer screening. The results of the systematic reviews were evaluated by the ACS Prostate Cancer Advisory Committee, and deliberations about the evidence occurred at committee meetings and during conference calls. On the basis of the evidence and a consensus process, the Prostate Cancer Advisory Committee developed the guideline, and a writing committee drafted a guideline document that was circulated to the entire committee for review and revision. The document was then circulated to peer reviewers for feedback, and finally to the ACS Mission Outcomes Committee and the ACS Board of Directors for approval. The ACS recommends that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information beginning at age 50 years. Men in higher risk groups should receive this information before age 50 years. Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources. Patient decision aids are helpful in preparing men to make a decision whether to be tested.

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

“…While screening recommendations vary somewhat by professional organization [5][6][7], the U.S. Preventive Services Task Force now recommends against routine screening for all ages [8]. In the midst of this debate, most men undergoing PCa screening are aware of the benefits, but fewer are aware of the limitations [9,10].…”

Recommendations from the EGAPP Working Group: does PCA3 testing for the diagnosis and management of prostate cancer improve patient health outcomes?

“…5 Recently, attention has been directed toward creating algorithms or nomograms that combine multiple clinical and laboratory features into risk scores to help in clinical decision making. [5][6][7][8] Nomograms are risk assessment tools that combine multiple clinical and laboratory risk factors to inform clinical decision making about biopsy, risk classification, and/or treatment options. Although there is wide variation in the manner in which the algorithms and nomograms have been developed and validated, a recent systematic review suggested that these tools tend to provide more accurate diagnostic predictions for cancer-positive biopsies than the use of PSA testing or other factors alone.…”

Risk-Based Prostate Cancer Screening: Who and How?

“…In the U.S. and Europe, guidelines recommend that clinicians begin offering PSA screening to men between 40 and 50 years of age [13][14][15][16]. Data from the ERSPC demonstrated a clear mortality benefit of PSA screening in men 55-59 years of age [7], as well as those 60-64 years of age [9••].…”