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Published on: November 2, 2013
Screening for prostate cancer: the current evidence and guidelines controversy
Leonard G Gomella1, Xiaolong S Liu, Edouard J Trabulsi
1Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
The Canadian Journal of Urology
|October 25, 2011
Summary
Prostate cancer screening guidelines are controversial and vary globally. Informed patient-physician discussion is crucial due to conflicting evidence on prostate specific antigen (PSA) screening benefits and risks.
Area of Science:
- Oncology
- Public Health
- Medical Guidelines
Background:
- Prostate cancer screening, particularly with prostate specific antigen (PSA), has increased diagnoses but raises concerns about over-diagnosis and overtreatment.
- The global public health impact of prostate cancer necessitates a clear understanding of screening efficacy and risks.
Purpose of the Study:
- To review current clinical trials, evidence-based recommendations, and guidelines for prostate cancer screening.
- To analyze the controversies and variations in prostate cancer screening protocols worldwide.
Main Methods:
- Systematic review of Medline for recent articles on prostate cancer screening.
- Analysis of clinical trials, evidence-based recommendations, and guidelines from major medical organizations.
Main Results:
- Screening trial results (ERSPC, PLCO, Göteborg) are conflicting, with some showing reduced mortality and others no benefit.
- Major medical organizations present diverse recommendations for prostate specific antigen (PSA) screening, ranging from baseline at age 40 to risk-stratified or against screening.
- Informed patient-provider discussion is a common recommendation across most guidelines.
Conclusions:
- Prostate cancer screening guidelines lack international and national consensus, highlighting significant controversy.
- Ongoing trials may provide further clarity, but currently, no standard of care exists.
- Shared decision-making between patients and physicians is essential for informed prostate cancer screening choices.
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