Tag Archives: screening systems

The American Urologic Association on Screening

The incredible blowback from various urologists who didn’t share the USPSTF guideline on screening has now been answered by the urologists (or at least their professional organization) themselves. In their just released guidelines, there is a more nuanced approach, but a clear recognition of the risks involved with screening, and adoption of an age-gated approach. Here are the core statements from their website:

Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years. (Recommendation; Evidence Strength Grade C)

  • In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.

Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. (Recommendation; Evidence Strength Grade C)

  • For men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualized.

Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences. (Standard; Evidence Strength Grade B)

  • The greatest benefit of screening appears to be in men ages 55 to 69 years.

Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. (Option; Evidence Strength Grade C)

  • Additionally, intervals for rescreening can be individualized by a baseline PSA level.

Guideline Statement 5: The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy. (Recommendation; Evidence Strength Grade C)

  • Some men over age 70 years who are in excellent health may benefit from prostate cancer screening.

As I have stated elsewhere in this blog, screening is viewed differently by men who have already been found to have prostate cancer, for all kinds of reasons, not least because they wish they were in the happy group of men who are doing fine and may or may not need to be detected. (or they feel that screening saved their life or could have…)

The bottom line remains that the decision is individual, and that going through the pros and cons is not a short discussion in a family practice office, or even less in the line at the 9 Health Fair or similar. It will take you at least 15 minutes to read through the VERY thoughtful AUA statement, which is the best summary I have read in a long time.

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Screening (from a 30,000 foot view)

When you go through the screening systems at our national airports, there are often videos that describe the process, reminding you to take any liquids out of your suitcase and so forth. I think it is time for cancer centers (and others) to do the same thing at their annual screening events for breast, prostate and other cancers. I have no problem with participating in screening events if the participants are fully informed about the benefits, risks, and the controversies surrounding screening for prostate cancer. However without such information, I fear that most men simply open Pandora’s box without really knowing what they are getting into. Does a 75 year old man realize that his chances of dying from prostate cancer are tiny compared to the other lurking causes of death? Does a 60 year old man understand that a Gleason 6 cancer can be followed safely with active surveillance, but that it will require “life long” repetitive biopsies? The NEJM article on this issue this week is worth everyone reading. Marketing should not be what medicine is about.


Filed under General Prostate Cancer Issues