Early Detection of Prostate Cancer: AUA Guideline

Abstract

Purpose The guideline purpose is to provide the urologist with a framework for the early detection of prostate cancer in asymptomatic average risk men. Materials and Methods A systematic review was conducted and summarized evidence derived from over 300 studies that addressed the predefined outcomes of interest (prostate cancer incidence/mortality, quality of life, diagnostic accuracy and harms of testing). In addition to the quality of evidence, the panel considered values and preferences expressed in a clinical setting (patient-physician dyad) rather than having a public health perspective. Guideline statements were organized by age group in years (age <40; 40 to 54; 55 to 69; >70). Results With the exception of prostate-specific antigen (PSA)-based prostate cancer screening, there was minimal evidence to assess the outcomes of interest for other tests. The quality of evidence for the benefits of screening was moderate, and evidence for harm was high for men age 55 to 69 years. For men outside this age range, evidence was lacking for benefit, but the harms of screening, including over diagnosis and over treatment, remained. Modeled data suggested that a screening interval of two years or more may be preferred to reduce the harms of screening. Conclusions The Panel recommended shared decision-making for men age 55 to 69 years considering PSA-based screening, a target age group for whom benefits may outweigh harms. Outside this age range, PSA-based screening as a routine could not be recommended based on the available evidence. The entire guideline is available at www.AUAnet.org/education/guidelines/prostate-cancer-detection.cfm

Receipt of Cancer Screening Is a Predictor of Life Expectancy

“…For example, the American Cancer Society and the American Urological Association both discourage PSA screening in men with life expectancy of less than 10 years, 28,29 while the American Cancer Society and U.S. Preventive Services Task Force advocate consideration of life expectancy in decisions about mammography screening. 28,30 Receipt of cancer screening by those with limited life expectancy can be used as a quality measure, and physicians could be assessed by the proportion of their patients with limited life expectancy who receive screenings, just as they are currently assessed by the proportion of their patients who do not receive screenings.…”

Prostate Cancer Screening

“…20 Over the past several years, the approach to Pca screening has shifted, because new findings indicate that the potential benefits from PSA testing are small. [22][23][24][25] For example, the Prostate Cancer Intervention vs Observation Trial concluded that among men with clinically localized Pca that had been diagnosed after PSA testing, radical prostatectomy did not reduce all-cause or prostate cancer mortality, compared with observation, through at least 12 years of follow-up. 26 Similarly, the European Randomized Study of Screening for Prostate Cancer concluded that to prevent a single death from Pca at 11 years of follow-up, more than 1050 men would need to be screened and 37 cancers would need to be detected.…”

“…As described by the US Preventive Services Task Force (USPSTF) 25 and others, 22,24 PSA-based screening for Pca sets in motion a clinical path leading to overdiagnosis and overtreatment of most patients who screen positive. Box 1 summarizes the expected harms, as well as the possible benefits.…”

A Comparison of Web-Based Versus Print-Based Decision Aids for Prostate Cancer Screening: Participants’ Evaluation and Utilization

“…1 Cancer-related organizations, as well as the US Preventive Services Task Force, have encouraged patients to engage in informed and shared decision making with their physician about prostate cancer screening, rather than engage in routine, annual screening. [2][3][4] Men have also expressed a desire for shared decision making for prostate cancer screening 5,6 and a need for more information about prostate cancer. 7 We recently completed a randomized controlled trial to test the impact of a print-based and a web-based decision aid for prostate cancer screening on behavioral and screening outcomes.…”