How does the approach to prostate cancer screening vary among guidelines?

Updated: Jan 14, 2019
  • Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Digital rectal examination (DRE) and PSA evaluation are the two components necessary for a modern screening prostate cancer program. However, there is controversy regarding screening.

Advocates of screening for prostate cancer believe that early detection is crucial to finding organ-confined disease and to reducing the likelihood of mortality. When symptoms develop or when DRE results become positive, most cases have already advanced beyond organ-confined disease. However, those who do not advocate screening worry that screening will detect cancers that are not biologically significant (ie, in patients who will die with prostate cancer rather than from it).

The American Cancer Society (ACS), [1] the American Urological Association (AUA), [2] and the National Comprehensive Cancer Network (NCCN), [3] have issued guidelines that differ on specific points but agree on the value of prostate cancer screening in selected populations, for patients who agree to screening after a discussion of the risks and benefits.

The U.S. Preventive Services Task Force (USPSTF) advises that in men aged 55 to 69 years, the decision of whether or not to undergo screening should be individualized. This is a grade C recommendation, meaning that there is at least moderate certainty that the net benefit is small. For men aged 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer. [4]

The European Society for Medical Oncology (ESMO) recommends against population-based PSA screening for prostate cancer on the grounds that it reduces prostate cancer mortality at the expense of overdiagnosis and overtreatment. [5]

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