Recent Developments in Prostate Cancer Screening Guidelines

Abstract

Screening recommendations must take into consideration the variable course of PCa for individual patients. While prostate cancer is commonly referred to as a slow growing process, this over-generalization is filled with potentially dangerous assumptions for individuals who harbor aggressive forms of disease. Widespread screening with prostate specific antigen began in the late 1980’s, with mortality due to prostate cancer in decline for the past two decades. This approach has led to a substantial decrease in the diagnosis of high-grade disease. Therefore, population-wide data supports the utility of prostate cancer screening with prostate specific antigen. The purpose of this article is to evaluate the current status of prostate screening in light of the US Preventative Service Task Force guidelines against routine screening and the more recently published American Urological Association guidelines for shared decision-making centered on patient education and autonomy. The difference in recommendations arises from the interpretation of the results from large, randomized prospective screening trials. While the studies may not illustrate a significant benefit for screening, they have notable limitations that make definitive conclusions based on their results, difficult to arrive. Epidemiologic data supports the use of screening modalities for diseases with high prevalence and a prolonged asymptomatic phase. As with any test, there are risks associated with prostate specific antigen screening. The major concerns are over diagnosis and over treatment. While the scientific community works toward more specific screening tests, it is imperative that individual patients are educated and involved in the shared decision-making. Patient perception of their individual harm and benefit becomes a major contributor to the decision-making process when evidence is largely inconclusive and unable to provide definitive direction for the practitioner.