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Last Updated: 5/8/2013  

Screening for Prostate Cancer

  • Recognize that the natural history of untreated prostate cancer is variable, with certain subsets of patients living for extended periods of time without active treatment intervention.

  • Be aware that black men and men with a first-degree relative with the disease are more likely to develop prostate cancer.

  • Appreciate that screening tests such as the PSA, or the DRE plus PSA, may detect prostate cancer before clinical symptoms of prostate cancer develop.

  • Realize that treatment (including surgery and radiation treatments) for prostate cancer detected from screening programs may have adverse effects that decrease overall quality of life for men so treated, with no evidence to determine whether survival is improved or not.

  • Appreciate that the disease-specific mortality may be lower for men with clinically detected or palpable-on-DRE prostate cancer who undergo radical prostatectomy compared to watchful waiting, but it is uncertain if this benefit extends to screen-detected disease.

  • Realize that there are conflicting data regarding prostate cancer mortality improvement from PSA-based testing.

  • Inform average-risk men aged 50 to 69 of the potential benefits and harms of screening and use PSA to screen only those who express a preference to be screened. Do not screen most men over 69 or those with life expectancy less than 10 to 15 years.

  • Be aware of the continued controversy regarding prostate cancer screening due to weaknesses in the randomized trials and the challenges of balancing a potential mortality benefit against the potential for overdiagnosis and overtreatment, which may lead to harms such as erectile dysfunction and incontinence.

DOI: 10.7326/s241
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Marc B. Garnick, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Eyad Al-Hihi, MD, MBA, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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