Early detection of prostate cancer: European Association of Urology recommendation

Eur Urol. 2013 Sep;64(3):347-54. doi: 10.1016/j.eururo.2013.06.051. Epub 2013 Jul 9.

Abstract

Background: The recommendations and the updated EAU guidelines consider early detection of PCa with the purpose of reducing PCa-related mortality and the development of advanced or metastatic disease.

Objective: This paper presents the recommendations of the European Association of Urology (EAU) for early detection of prostate cancer (PCa) in men without evidence of PCa-related symptoms.

Evidence acquisition: The working panel conducted a systematic literature review and meta-analysis of prospective and retrospective clinical studies on baseline prostate-specific antigen (PSA) and early detection of PCa and on PCa screening published between 1990 and 2013 using Cochrane Reviews, Embase, and Medline search strategies.

Evidence synthesis: The level of evidence and grade of recommendation were analysed according to the principles of evidence-based medicine. The current strategy of the EAU recommends that (1) early detection of PCa reduces PCa-related mortality; (2) early detection of PCa reduces the risk of being diagnosed and developing advanced and metastatic PCa; (3) a baseline serum PSA level should be obtained at 40-45 yr of age; (4) intervals for early detection of PCa should be adapted to the baseline PSA serum concentration; (5) early detection should be offered to men with a life expectancy ≥ 10 yr; and (6) in the future, multivariable clinical risk-prediction tools need to be integrated into the decision-making process.

Conclusions: A baseline serum PSA should be offered to all men 40-45 yr of age to initiate a risk-adapted follow-up approach with the purpose of reducing PCa mortality and the incidence of advanced and metastatic PCa. In the future, the development and application of multivariable risk-prediction tools will be necessary to prevent over diagnosis and over treatment.

Keywords: Advanced Prostate Cancer; Baseline PSA; EAU Guidelines; Metastasis; PSA; Prostate Cancer; Screening.

Publication types

  • Meta-Analysis
  • Practice Guideline
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Decision Support Techniques
  • Early Detection of Cancer / standards*
  • Humans
  • Kallikreins / analysis
  • Life Expectancy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prognosis
  • Prostate-Specific Antigen / analysis
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / therapy
  • Risk Factors
  • Time Factors
  • Unnecessary Procedures
  • Urology / standards*

Substances

  • Kallikreins
  • kallikrein-related peptidase 3, human
  • Prostate-Specific Antigen