Here is the latest American Cancer Society Prostate Cancer Screening
Guidelines press release.
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Update Reaffirms the Importance of Shared Decision-Making
ATLANTA –March 3, 2010 – Newly updated prostate cancer screening guidelines from
the American Cancer Society reaffirm the recommendation that men should discuss the
uncertainties, risks and potential benefits of screening for prostate cancer before deciding
whether to be tested. The update is the first since 2001 and was done as part of the
Society’s regular guidelines update process. It included a series of systematic reviews
focusing on the latest evidence related to the early detection of prostate cancer, screening
test performance, harms of therapy for localized prostate cancer, and shared and informed
decision making in prostate cancer screening.
The guideline is published online in advance of print publication in CA: A Cancer
Journal for Clinicians. The updated guidelines include these recommendations:
*Asymptomatic men who have at least a ten-year life expectancy should
have an opportunity to make an informed decision with their health care
provider about screening for prostate cancer after receiving information
about the uncertainties, risks, and potential benefits associated with
*Men at average risk should receive this information beginning at age 50.
Men at higher risk, including African American men and men with a first
degree relative (father or brother) diagnosed with prostate cancer before
age 65, should receive this information beginning at age 45. Men at
appreciably higher risk (multiple family members diagnosed with prostate
cancer before age 65) should receive this information beginning at age 40.
*Men should either receive this information directly from their health care
providers or be referred to reliable and culturally appropriate sources.
*Patient decision aids are helpful in preparing men to make a decision
whether to be tested.
*Prostate cancer screening should not occur without an informed decision
making process.
*Asymptomatic men who have less than a ten-year life expectancy based
on age and health status should not be offered prostate cancer screening.
*For men who are unable to decide, the screening decision can be left to the
discretion of the health care provider, who should factor into the decision
his or her knowledge of the patient’s general health preferences and
“Two decades into the PSA era of prostate cancer screening, the overall value of
early detection in reducing the morbidity and mortality from prostate cancer remains
unclear,” said Andrew M. Wolf, M.D., Associate Professor of Medicine at the University
of Virginia Health System and Chair of the Advisory Committee. “While early detection
may reduce the likelihood of dying from prostate cancer, that benefit must be weighed
against the serious risks associated with subsequent treatment, particularly the risk of
treating men for cancers that would not have caused ill effects had they been left
The authors say in light of ongoing uncertainties, including the uncertain balance
between benefits and risks, involving men in the screening decision is crucial. “With
these newly updated recommendations, the American Cancer Society places even
stronger emphasis on shared decision making between clinicians and patients,” said Otis
Brawley, M.D., chief medical officer of the American Cancer Society. “The decision
whether to screen should be made with the help of a trusted source of regular care. Men
without access to regular care should not be tested unless high-quality informed decisionmaking
as well as appropriate counseling and follow-up care for those who test positive
can be assured. Without those, community-based screening should not be initiated.”
“Previous guidelines from the American Cancer Society and other organizations
have discussed the importance of informed decision making for men who are considering
prostate cancer screening, however this update is the first to provide details regarding
what information about screening is needed for informed decision-making to occur,” said
Alan G. Thorson, M.D., F.A.C.S., volunteer president of the Society. “For that reason,
the updated ACS guidelines delineate the core elements of information necessary for men
to engage meaningfully in this decision, and encourage inclusion of this information in
patient discussions and decision aids.”
The guidelines also includes updated clinical recommendations regarding
screening tests, intervals, and follow up of abnormal results for those men who choose to
be screened after considering the possible benefits and risks. The guidelines acknowledge
the limited contribution of digital rectal exam (DRE) to prostate cancer early detection
and state that screening can be performed using PSA with or without the DRE. The
guidelines recommend annual screening for men whose PSA level is 2.5 ng/ml or higher,
but state that screening intervals can be safely extended to every two years for men
whose PSA is less than 2.5 ng/ml. The guidelines affirm that a PSA level of 4.0 ng/ml or
higher remains a reasonable threshold to recommend referral for further evaluation or
biopsy for men at average risk of developing prostate cancer; for PSA levels between 2.5
and 4.0 ng/ml, health care providers should consider an individualized risk assessment
that incorporates other risk factors for prostate cancer in the referral decision.
The update included a complete review of the evidence. The American Cancer
Society’s Prostate Cancer Advisory Committee, composed of independent researchers,
clinicians and lay people, examined systematic reviews done by scientific experts at
Emory University, Rollins School of Public Health, met to hear presentations by experts
both on the Committee and by invited outside experts, and deliberated the evidence
before making its final recommendations. The guideline underwent peer review before
going before the American Cancer Society volunteer Board of Directors for approval.
The authors conclude by noting the urgent need for better ways to detect and treat
early-stage prostate cancer, particularly the need to distinguish between cancers that do
not require treatment and those that are aggressive, to help “tip the balance clearly in
favor of screening. Until that time, however, it will remain incumbent on health care
providers and the health care system as a whole to provide men with the opportunity to
decide whether they wish to pursue early detection of prostate cancer.”
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