Screening for Prostate Cancer: A Review of the Evidence for the U.S. Preventive Services Task Force

Oregon Health & Science University, Portland, Oregon 97239, USA.
Annals of internal medicine (Impact Factor: 17.81). 12/2011; 155(11):762-71. DOI: 10.1059/0003-4819-155-11-201112060-00375
Source: PubMed


Screening can detect prostate cancer at earlier, asymptomatic stages, when treatments might be more effective.
To update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer.
MEDLINE (2002 to July 2011) and the Cochrane Library Database (through second quarter of 2011).
Randomized trials of prostate-specific antigen-based screening, randomized trials and cohort studies of prostatectomy or radiation therapy versus watchful waiting, and large observational studies of perioperative harms.
Investigators abstracted and checked study details and quality using predefined criteria.
Of 5 screening trials, the 2 largest and highest-quality studies reported conflicting results. One found that screening was associated with reduced prostate cancer-specific mortality compared with no screening in a subgroup of men aged 55 to 69 years after 9 years (relative risk, 0.80 [95% CI, 0.65 to 0.98]; absolute risk reduction, 0.07 percentage point). The other found no statistically significant effect after 10 years (relative risk, 1.1 [CI, 0.80 to 1.5]). After 3 or 4 screening rounds, 12% to 13% of screened men had false-positive results. Serious infections or urine retention occurred after 0.5% to 1.0% of prostate biopsies. There were 3 randomized trials and 23 cohort studies of treatments. One good-quality trial found that prostatectomy for localized prostate cancer decreased risk for prostate cancer-specific mortality compared with watchful waiting through 13 years of follow-up (relative risk, 0.62 [CI, 0.44 to 0.87]; absolute risk reduction, 6.1%). Benefits seemed to be limited to men younger than 65 years. Treating approximately 3 men with prostatectomy or 7 men with radiation therapy instead of watchful waiting would each result in 1 additional case of erectile dysfunction. Treating approximately 5 men with prostatectomy would result in 1 additional case of urinary incontinence. Prostatectomy was associated with perioperative death (about 0.5%) and cardiovascular events (0.6% to 3%), and radiation therapy was associated with bowel dysfunction.
Only English-language articles were included. Few studies evaluated newer therapies.
Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.
Agency for Healthcare Research and Quality.

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Available from: Jennifer M Croswell, Apr 08, 2014
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    • "*Due to small sample size, GPs working in the regional and rural sectors were combined and labelled as rural practice in the analysis. et al. 2012; Andriole et al. 2012; Chou et al. 2011), leading to decrease in PC screening in the USA (Aslani et al. 2013). In Australia, the leading bodies have completely opposing guidelines. "
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    ABSTRACT: This study aims to examine the current practice of General practitioners (GPs)/primary care physicians in opportunistic screening for prostate cancer (PC) by digital rectal examination(DRE) and Prostate Specific Antigen(PSA) testing and identify any difference in screening practice. Printed copies and/or electronic versions of a survey was distributed amongst 438 GPs throughout Australia in 2012. Statistical analyses (Wilcoxon rank-sum test, Fisher’s exact test or Pearson chi-square test)were performed by outcomes and GP characteristics.There were a total of 149 responses received (34%), with similar gender distribution in rural and metropolitan settings. 74% GPs believed PSA testing was at least ‘somewhat effective’ in reducing PC mortality with annual PSA screening being conducted by more GPs in the metropolitan setting compared to the rural GPs (35% vs 18.4%), while 25% of rural GPs would not advocate routine PSA screening. When examining the concordance between DRE and PSA testing by gender of GP, the male GPs reported performing PSA testing more frequently than DRE in patients between ages 40 to 69 (p = 0.011). Urology Society guidelines (77.2%) and College of GPs (73.2%) recommendations for PC screening were thought to be at least ‘somewhat useful’. Although reference ranges for PSA tests were felt to be useful, the majority (65.8%) found it easier to refer to an urologist due to the disagreements in guidelines. In conclusion, the current guidelines for PSA screening appear to cause more confusion due to their conflicting advice, leaving GPs to formulate their own practice methods, calling for an urgent need for uniform collaborative guidelines. Electronic supplementary material The online version of this article (doi:10.1186/s40064-015-0819-8) contains supplementary material, which is available to authorized users.
    SpringerPlus 02/2015; 4(1):78. DOI:10.1186/s40064-015-0819-8
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    • "Finally, a key concern of study participants was how to help men decipher screening and treatment recommendations . For few health issues is this more of a problem than in prostate cancer where there is no consensus on workup and treatment (American Cancer Society, 2012; Chou et al., 2011; Smith et al., 2009; Taylor et al., 2012; U.S. Preventive Services Task Force, 2012). Further complicating this decision process is the scarcity of African American physicians and urologic specialists in the region, an issue almost universally voiced by key informants . "
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    ABSTRACT: African American men face the highest rates of prostate cancer, yet with no consensus for screening and treatment, making informed health care decisions is difficult. This study aimed to identify approaches to empowering African American men as proactive participants in prostate cancer decision making using an established community-campus partnership employing elements of community-based participatory research methods. Community stakeholders with an interest in, and knowledge about, health care in two local African American communities were recruited and completed key informant interviews (N = 39). Grounded theory coding identified common themes related to prostate cancer knowledge, beliefs, attitudes, and responses to them. Common barriers such as gender roles, fear, and fatalism were identified as barriers to work-up and treatment, and both communities' inadequate and inaccurate prostate cancer information described as the key problem. To build on community strengths, participants said the change must come from inside these communities, not be imposed from the outside. To accomplish this, they suggested reaching men through women, connecting men to doctors they can trust, making men's cancer education part of broader health education initiatives designed as fun and inexpensive family entertainment events, and having churches bring community members in to speak on their experiences with cancer. This study demonstrated the success of community engagement to identify not only barriers but also local strengths and facilitators to prostate cancer care in two suburban/rural African American communities. Building collaboratively on community strengths may improve prostate cancer care specifically and health care in general. © The Author(s) 2015.
    American journal of men's health 01/2015; DOI:10.1177/1557988314566503 · 1.15 Impact Factor
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    • "A recently updated Cochrane review (Ilic et al, 2011) of five randomised controlled trials, a meta-analysis (Djulbegovic et al, 2010) of six randomised controlled trials, including the ERSPC, PLCO and 20-year-follow-up of a small, long-term trial (Sandblom et al, 2011) do not provide strong evidence that screening causes reductions in allcause or prostate cancer-specific mortality that are important enough to outweigh potential harms. The recent updated report from the US Preventive Services Task Force recommended against routine PSAbased screening (Chou et al, 2011). However, the controversy surrounding these draft recommendations (Brett and Ablin, 2011; McNaughton-Collins and Barry, 2011) suggests continuing concerns about the methodological quality of some evidence and associated risks of bias. "
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    ABSTRACT: Background: Screening for prostate cancer continues to generate controversy because of concerns about over-diagnosis and unnecessary treatment. We describe the rationale, design and recruitment of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP) trial, a UK-wide cluster randomised controlled trial investigating the effectiveness and cost-effectiveness of prostate-specific antigen (PSA) testing. Methods: Seven hundred and eighty-five general practitioner (GP) practices in England and Wales were randomised to a population-based PSA testing or standard care and then approached for consent to participate. In the intervention arm, men aged 50–69 years were invited to undergo PSA testing, and those diagnosed with localised prostate cancer were invited into a treatment trial. Control arm practices undertook standard UK management. All men were flagged with the Health and Social Care Information Centre for deaths and cancer registrations. The primary outcome is prostate cancer mortality at a median 10-year-follow-up. Results: Among randomised practices, 271 (68%) in the intervention arm (198 114 men) and 302 (78%) in the control arm (221 929 men) consented to participate, meeting pre-specified power requirements. There was little evidence of differences between trial arms in measured baseline characteristics of the consenting GP practices (or men within those practices). Conclusions: The CAP trial successfully met its recruitment targets and will make an important contribution to international understanding of PSA-based prostate cancer screening.
    British Journal of Cancer 05/2014; 110(12). DOI:10.1038/bjc.2014.242 · 4.84 Impact Factor
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