Cancer Society prostate Ca screening guidelines stress informed decision making

Men should discuss the uncertainties, risks, and potential benefits of screening for prostate cancer before deciding whether to be tested, according to newly updated prostate cancer screening guidelines from the American Cancer Society.

The update, the first since 2001, was published online in CA: A Cancer Journal for Clinicians (March 3, 2010). Recommendations from the updated guidelines include:

• Asymptomatic men who have at least a 10-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 screening.
• Men at average risk should receive information on screening beginning at age 50. Men at higher risk should receive this information beginning at age 45. Men at appreciably higher risk 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 10-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 provider, who should factor into the decision their knowledge of the patient’s general health preferences and values.

In a statement, AUA President Anton J. Bueschen, MD said the association "applauds the American Cancer Society (ACS) for its new guidance statement on prostate cancer detection."

"However, the new ACS statement may not fully characterize the potential benefits of an individualized approach to assessing risk in men considering the risk and benefits of early detection strategies and may cause significant confusion for patients. The AUA feels there is no single PSA standard that applies to all men, nor should there be. Part of informed consent is giving patients as much information about their personal risk as is available. Applying population-based cut points while ignoring other individual risk factors (such as age, ethnicity, family history, previous biopsy characteristics, etc.) may not give a patient the most optimal assessment of his risk, including the risk of high-grade disease."

The ACS update also prompted a response from the Prostate Cancer Foundation in which it reiterated its position that PSA screening remains a valuable tool, in combination with other tools, for identifying potential prostate disease, including cancer. It is also calling for more reasoned discussion that empowers patients and their physicians and improves patients’ understanding of PSA data, prostate cancer, and treatment options.

"Every man has the right to know if he has cancer and to make informed decisions with his urologist," Jonathan W. Simons, MD, of the Prostate Cancer Foundation, said in a statement. "This requires a thorough dialogue between patients, family members, and urologists that weighs the pros and cons of screening and treatment options. While medical specialists know that the current PSA test is imperfect, it can be an important tool for diagnosing various problems with the prostate and taking care of men’s health."