Prostate cancer screening
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Screening
Prostate cancer screening is an attempt to find unsuspected cancers. Screening tests may lead to more specific follow-up tests such as a biopsy, where small cores of the prostate are removed for closer study. Prostate cancer screening options include the digital rectal exam and the prostate specific antigen (PSA) blood test. Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.
Prostate cancer is usually a slow-growing cancer, very common among older men. In fact, most prostate cancers never grow to the point where they cause symptoms, and most men with prostate cancer die of other causes before prostate cancer has an impact on their lives. The PSA screening test may detect these small cancers that would never become life threatening. Doing the PSA test in these men may lead to overdiagnosis, including additional testing and treatment. Follow-up tests, such as prostate biopsy, may cause pain, bleeding and infection. Prostate cancer treatments may cause urinary incontinence and erectile dysfunction. Therefore, it is essential that the risks and benefits of diagnostic procedures and treatment be carefully considered before PSA screening.
Several medical societies have not found sufficient evidence to support routine screening for prostate cancer - but the American Urological Association supports annual screening and digital examination for men over 50 years old - and starting earlier for 'men at high risk (those with a family history of prostate cancer or African American men)'. [1]
- In 2002, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to recommend for or against routine screening for prostate cancer using PSA testing or digital rectal examination (DRE).[2] The previous 1995 USPSTF recommendation was against routine screening.
- In 1997, American Cancer Society (ACS) guidelines began recommending that beginning at age 50 (age 45 for African-American men and men with a family history of prostate cancer, and since 2001, age 40 for men with a very strong family history of prostate cancer), PSA testing and DRE be offered annually to men who have a life-expectancy of 10 or more years (average life expectancy is 10 years or more for U.S. men under age 76)
[3] along with information on the risks and benefits of screening.[4] The previous ACS recommendations since 1980 had been for routine screening for prostate cancer with DRE annually beginning at age 40, and since 1992 had been for routine screening with DRE and PSA testing annually beginning at age 50.
- ↑ Early Detection of Prostate Cancer, American Urological Association, Washington, D.C., revised: October 2008.Accessed: 12-01-2008
- ↑ US Preventive Services Task Force (2002). "Screening for Prostate Cancer". Agency for Healthcare Research and Quality. Unknown parameter
|month=ignored (help) USPSTF (2002). "Screening for prostate cancer: recommendation and rationale" (PDF). Ann Intern Med. 137 (11): 915–6. PMID 12458992. Unknown parameter|month=ignored (help)
Harris R, Lohr KN (2002). "Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force" (PDF). Ann Intern Med. 137 (11): 917–29. PMID 12458993. Unknown parameter|month=ignored (help) - ↑ Arias E (2006). "United States Life Tables, 2003" (PDF). Natl Vital Stat Rep. 54 (14): 1–40. PMID 16681183. Unknown parameter
|month=ignored (help) - ↑ von Eschenbach A, Ho R, Murphy GP, Cunningham M, Lins N (1997). "American Cancer Society guideline for the early detection of prostate cancer: update 1997" (PDF). CA Cancer J Clin. 47 (5): 261–4. doi:10.3322/canjclin.47.5.261. PMID 9314820. Unknown parameter
|month=ignored (help)ACS (2007). "Prostate Cancer: Early Detection". Retrieved 2007-11-19. Unknown parameter|month=ignored (help)
Smith RA, Cokkinides V, Eyre HJ (2007). "Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects" (PDF). CA Cancer J Clin. 57 (2): 90–104. PMID 17392386. Unknown parameter|month=ignored (help)
Smith RA, Cokkinides V, Eyre HJ (2006). "American Cancer Society guidelines for the early detection of cancer, 2006" (PDF). CA Cancer J Clin. 56 (1): 11–25. PMID 16449183. Unknown parameter|month=ignored (help)