Template: Disc Prostate Screen ***Prostate Screening****
1. The American Cancer Society (ACS) emphasizes the need for involving men in the decision whether to screen for prostate cancer. A handout is provided that is evidenced based and explains the risks and benefits of screening. Most experts now conclude that the harms of screening outweigh the benefits.
2. The American Urological Association (AUA) strongly recommends shared decision making in deciding on PSA screening in men ages 55 to 69. The guideline panel could find no evidence to support the continued use of DRE as a first-line method of screening. The AUA stated that a screening interval of two years for men who choose screening may be preferred to annual screening and that screening intervals can be individualized based on baseline PSA level. The guideline noted the lack of evidence for using any tests (eg, PSA derivatives, PSA kinetics, PSA molecular markers, urinary markers, imaging, or risk calculators) other than PSA for triggering a biopsy referral. While the AUA did not recommend a specific threshold for biopsy referral, they did suggest using a threshold of 10.0 ng/mL for men 70 years and older.
3. The United States Preventive Services Task Force (USPSTF) updated its recommendations in 2012 to recommend that men NOT be screened for prostate cancer, concluding that there is moderate certainty that the benefits of such screening do not outweigh the harms. The USPSTF did advise that men requesting screening be supported in making an informed decision.
4. The Canadian Task Force on Preventive Health Care recommends against screening for prostate cancer with PSA or TRUS and states that there is insufficient evidence recommend for or against screening with DRE.
5. The United Kingdom National Screening Committee does not recommend screening for prostate cancer.
6. The Australian Cancer Council states that the evidence does not support population-based screening and recommends a patient-centered approach that individualizes the decision.
7. The European Society for Medical Oncology (ESMO) recommends against population based screening and in favor of an individualized approach using shared decision making.
8. The Clinical Guidelines Committee of the American College of Physicians (ACP) produced a guidance statement in 2013 based on their rigorous review of guidelines developed by other United States organizations, including the American College of Preventive Medicine, the American Cancer Society, the American Urological Association, and the US Preventive Services Task Force [171]. The ACP guidance statement recommends that clinicians inform men ages 50 to 69 about the limited potential benefits and substantial harms of prostate cancer screening and only screen men who express a clear preference for being screened. The guidance statement also recommends against screening for prostate cancer in average-risk men under the age of 50 and against screening in men over the age of 69 or with a life expectancy less than 10 to 15 years.
