Prevention, Screening and Health Maintenance
Family Medicine Clerkship
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Prostate Cancer Screening
What are the current recommendations for prostate
US Preventive Services Task Force:
- There is no current evidence to support annual
PSA testing and DRE examinations for men over 50 years of
- This does not mean that men with possible symptoms of
prostate cancer should not be tested.
- It does mean that a large sector of the medical
community will not endorse annual PSA tests and DREs for
American College of Physicians:
- Recommendation 1: Rather than screening all men for
prostate cancer as a matter of routine, physicians should
describe the potential benefits and known harms of
screening, diagnosis and treatment; listen to the
patient's concerns; and then individualize the decision to
- Recommendation 2: The College strongly recommends that
physicians help enroll men in ongoing studies.
American Urological Association:
- All males of 50 years or more should have an annual
prostate examination comprising a digital rectal
examination and a PSA test.
- All males of 40 years or more with a family history of
prostate cancer should have an annual prostate examination
comprising a digital rectal examination and a PSA test.
American Cancer Society:
- Beginning at age 50, an annual prostate examination,
including a digital rectal examination and a PSA test,
should be offered annually to men who have a life
expectancy of at least 10 years, and to younger men who
are at high risk
Is there a suvival advantage for early screening of
- There is controversy as to what is an appropriate
treatment strategy for cancer prostate.
- There is one view that treatment modalities do not
have a proven survival advantage.
- Hence it is difficult to come up with a recommendation
for population screening.
What is the role of imaging procedures in
prostate cancer screening?
- Transrectal prostate ultrasound has been considered by
some to be a potentially useful screening modality.
- Among other radiologic modalities (i.e. CT and MRI),
ultrasound has a better potential for screening utility.
- Disadvantages include low sensitivity (71% to 92% for
cancer and 60% to 80% for subclinical disease) and
specificity (49% to 79%).
- Positive predictive value was also found to be
relatively low at 30%.
- As a single test for the screening of prostate cancer,
ultrasound has a very low yield.
- However, when used as a diagnostic exam in the
presence of a positive PSA or DRE, the yield is much
- Ultrasound does not play any role, at this time, in
screening for prostate cancer.
- Bottom line: ultrasound is not good for screening, but
is helpful for workup of suspected prostate cancer.