Prostate Cancer Screening
What are the current recommendations for prostate cancer screening?
US Preventive Services Task Force:
- There is no current evidence to support annual PSA testing and DRE examinations for men over 50 years of age.
- 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 asymptomatic males.
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 screen.
- 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 prostate cancer?
- 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 recomendation for population screening.
What is the role of imaging procedues in prostate cancer screening ?
Answer:
- Transrectal prostate Ultrasound has been considered by some to be 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 better.
- Ultrasound does not play any role, at this time, in screening for prostate cancer.
- Bottom line: Not good for screening, good for workup of suspected prostate cancer.