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Editorial Comment

      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.
      • Moyer V.A.
      Screening for prostate cancer: U.S. Preventive Services Task Force Recommendation Statement.
      • Carter H.B.
      • Albertsen P.C.
      • Barry M.J.
      • et al.
      Early detection of prostate cancer: AUA Guideline.
      • Wolf A.M.
      • Wender R.C.
      • Etzioni R.B.
      • et al.
      American Cancer Society guideline for the early detection of prostate cancer: update 2010.
      • Carroll P.R.
      • Parsons J.K.
      • Andriole G.
      • et al.
      NCCN Guidelines insights: prostate cancer early detection, version 2.2016.
      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.
      • Jemal A.
      • Fedewa S.A.
      • Ma J.
      • et al.
      Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations.
      • Hu J.C.
      • Nguyen P.
      • Mao J.
      • et al.
      Increase in prostate cancer distant metastases at diagnosis in the United States.
      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.
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