Prostate Cancer Screening: A Review of Current Recommendations

Shannon Vane

Disclosures

Urol Nurs. 2019;39(3):133-138. 

In This Article

Abstract and Introduction

Abstract

This review provides a synopsis of the background of prostate cancer screening, including risk factors, barriers, and disputed recommendations. Current evidence-based prostate cancer screening recommendations are presented then compared to previous guidelines. Finally, implications for practice are provided.

Introduction

In the United States, prostate cancer is one of the most prevalent cancers in men and the second most pervasive cancer-related death in men (National Cancer Institute [NCI], 2017). Data from the Surveillance, Epidemiology, and End Results (SEER) Program describe that during the years 2013–2015, the average American male had an 11.2% risk of developing prostate cancer in his lifetime (NCI, 2017). In 2018, over approximately 165,000 new cases have been reported, with the average age of diagnosis between 65 to 74 years (NCI, 2017). Prostate cancer affects men of all ethnicities and backgrounds, with an estimated 29,430 deaths in 2018; the highest rates of mortality in men between the ages of 75 to 84 years (NCI, 2017).

Demographically, the most vulnerable male is one who has one or more first-degree relatives with a history of prostate cancer (Carter et al., 2013). Black men remain at the highest risk, with the leading death rates of prostate cancer in the United States compared to men of other races and ethnicities (39.9% for Black men, 19.8% for non-Hispanic men, 19.8% for Alaska Native/Native American men, 18.2% for Caucasian men, 16.2% for Hispanic men, and 8.8% for Asian/Pacific Islander men (Noone et al., 2018). Although the cause for abnormal rates in different ethnicities is unknown, barriers in knowledge, health experiences related to screening, and health literacy regarding the purpose, harms, and benefits of prostate-specific antigen (PSA) testing may be factors for this highly vulnerable population (Ogunsanya et al., 2017).

The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC) provided the first assessment of the effects of PSA screening in the early 2000s (Pinksy et al., 2017; Schröder et al., 2014). Although results from these trials provided clarification on harms and benefits of PSA screening in the early detection of prostate cancer, the controversy regarding screening effectiveness and screening strategy persisted due to conflicting results that created variances among organizational guidelines and provider interpretation (Kim & Andriole, 2015).

The debate on screening effectiveness in reducing mortality rate and quality of life improvement has been a controversial issue among the healthcare community (Kim & Andriole, 2015). Concerns regarding different guideline standards and methods of implementation on PSA screening and patient-provider involvement has led to a fear of mismanagement of prostate cancer (Kim & Andriole, 2015). Various testing recommendations manifested from the lasting discussion on the effectiveness of PSA screening, providing evidence of possible harm resulting from over-testing without active surveillance or shared decision-making, leading to unnecessary prostate biopsies (Alberts, Schoots, & Roobol, 2015). Further speculation persists among providers and organizational guidelines regarding the limits of PSA levels, positing that level thresholds are too vague with the high-level cutoff in question, eliciting the need for further evaluation (Taboayoyong & Aboussaly, 2015).

One result from the multiple updates and changes over the past decade is that recommendations for PSA screening have fluctuated such that provider-patient discussions occur, and decisions are individualized. This patient-centered format is supported (decision after discussion with the provider) by numerous organizations, including the American Cancer Society (ACS) (2018), American Urological Association (AUA) (2019), and United States Preventive Services Task Force (USPSTF) (2018). The purpose of this review is to discuss barriers to prostate cancer screening in the clinical setting and provide a synopsis of current recommendations.

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