Screening asymptomatic men for prostate cancer: A comparison of international guidelines on prostate-specific antigen testing

Abstract

Objective To summarise and compare the key recommendations on prostate-specific antigen (PSA)-based screening for prostate cancer, and so highlight where more evidence is required to facilitate consistent recommendations. Methods The Medline database and websites of 18 national screening organisations and professional associations were searched between January 2010 and November 2020 to identify screening guidelines published in English, considering recent clinical trials. Results Population-based PSA testing of asymptomatic men is not widely recommended. Guidelines emphasize shared patient-clinician decision making. For ‘average-risk’ men choosing to be screened, the recommended age varies from 50–55 to 70 years, alongside consideration of life expectancy (ranging from 7–15 years). Screening intervals, when specified, are biennial (most common), annual, or determined from baseline PSA. The earliest age for screening high-risk men (frequently defined as of African descent or with a family history of prostate cancer) is 40 years, but recommendations often defer to clinical judgement. Conclusions Population screening of asymptomatic men is not widely recommended. Instead, balancing the potential harms and benefits of PSA testing is endorsed. Variation between guidelines stems from differing interpretations of key trials and could lead to clinician-dependent screening views. The development of clinical decision aids and international consensus on guidelines may help reduce national and international variation on how men are counselled.

Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps

“…Men may therefore be offered testing on request, after appropriate counselling. 100 The US and European Union policies and the unique policies in Lithuania and Sweden are summarised below.…”

Designing a Simple Electrochemical Genosensor for the Detection of Urinary PCA3, a Prostate Cancer Biomarker

“…The early detection of PCa is imperative due to its asymptomatic nature and symptom overlap with benign prostatic conditions [2]. Reliable diagnostic methods are critical for reducing mortality rates and enhancing the efficacy of medical interventions [3,4].…”

Public health perspective on prostate-specific antigen screening: Implications of overdiagnosis and differences in health insurance systems across countries

“…Jackson et al 1 summarize guidelines for prostate-specific antigen (PSA) screening that vary by country and point to the need for appropriate decision aids. It has been carefully reviewed, and the differences and problems of each country's guidelines are clearly described.…”

“…Of the guidelines (for men at average and high risk) listed in their table, 1 the US Preventive Services Task Force (USPSTF) recommendations are made solely by public health physicians, while others are made mainly by urologists. In the US, the 2012 USPSTF's Grade D recommendation (not recommended) was strongly opposed by the American Urological Association (AUA), claiming that PSA screening reduces cancer mortality.…”

“…It has been carefully reviewed, and the differences and problems of each country's guidelines are clearly described. For any new decision aid, I would like to recommend that three points be taken into consideration: Urologists and public health physicians have slightly different ideas. Ethnicity and genetic risk do not change the benefits of PSA screening. Whether medical expenses are covered by public or private insurance varies by country. Of the guidelines (for men at average and high risk) listed in their table, 1 the US Preventive Services Task Force (USPSTF) recommendations are made solely by public health physicians, while others are made mainly by urologists. In the US, the 2012 USPSTF's Grade D recommendation (not recommended) was strongly opposed by the American Urological Association (AUA), claiming that PSA screening reduces cancer mortality.…”