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: Except prostate specific antigen-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 overtreatment, 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.

Keywords: DRE; ERSPC; European Randomized Study of Screening for Prostate Cancer; FDA; Food and Drug Administration; PLCO; PSA; Prostate Lung, Colorectal and Ovarian; RCT; digital rectal examination; early detection of cancer; prostate specific antigen; prostate-specific antigen; prostatic neoplasms; randomized controlled trial.

Figur 1

Influence of evidence and interpretation on policy creation