The controversies surrounding routine use of prostate-specific antigen (PSA) and digital
rectal examination for prostate cancer screening are now well known. To a large degree,
this clinical debate is attributable to the marked disagreement ranging from the United
States Preventive Services Task Force issuing a grade D recommendation against prostate
cancer screening for all men at average risk for prostate cancer contrasted to the
American Urological Association, American Cancer Society, and National Comprehensive
Cancer Network endorsing shared decision making (SDM) about reviewing the merits of
screening and eliciting patient preferences into the decision for early detection
of prostate cancer.
1
,
2
,
3
,
4
More recently, however, several studies have found lower rates of PSA screening and
incidence of prostate cancer balanced against the recent increased rate of distant
metastasis among older men in the United States.
5
,
6
At this time of uncertainty regarding prostate cancer screening, it is now more important
for patients and providers to engage in thoughtful discussions about the risks and
benefits of a PSA test and incorporate SDM into the clinical encounter.- Hu J.C.
- Nguyen P.
- Mao J.
- et al.
Increase in prostate cancer distant metastases at diagnosis in the United States.
JAMA Oncol. 2016; https://doi.org/10.1001/jamaoncol.2016.5465
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References
- Screening for prostate cancer: U.S. Preventive Services Task Force Recommendation Statement.Ann Intern Med. 2012; 157: 120-134
- Early detection of prostate cancer: AUA Guideline.J Urol. 2013; 190: 419-426
- American Cancer Society guideline for the early detection of prostate cancer: update 2010.CA Cancer J Clin. 2010; 60: 70-98
- NCCN Guidelines insights: prostate cancer early detection, version 2.2016.J Natl Compr Canc Netw. 2016; 14: 509-519
- Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations.JAMA. 2015; 314: 2054-2061
- Increase in prostate cancer distant metastases at diagnosis in the United States.JAMA Oncol. 2016; https://doi.org/10.1001/jamaoncol.2016.5465
- Shared decision making and use of decision AIDS for localized prostate cancer: perceptions from radiation oncologists and urologists.JAMA Intern Med. 2015; 175: 792-799
- A randomized controlled effectiveness trial for PSA screening decision support interventions in two primary care settings.J Gen Intern Med. 2015; 30: 810-816
- Responses to a decision aid on prostate cancer screening in primary care practices.Am J Prev Med. 2015; 49: 520-525
Article info
Publication history
Published online: April 10, 2017
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© 2017 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
