Early Detection Prostate Cancer Flashcards
What is the recommendation for PSA screening in men under age 40 years?
The Panel recommends against PSA screening in men under age 40 years.
What is the prevalence of prostate cancer in men under age 40 years?
The prevalence of prostate cancer in men under age 40 years is extremely low, about 0.1%.
Are there any data available to estimate the benefit of prostate cancer screening in men under age 40 years?
No, there are no data available to estimate the benefit of prostate cancer screening in men under age 40 years as none of the prospective randomized studies evaluating the benefits of PSA-based screening included men under age 40 years.
What are the harms of PSA screening in men under age 40 years?
The harms of PSA screening in men under age 40 years include the side effects of diagnostic biopsies and perhaps subsequent treatment.
Why is screening discouraged for men under age 40 years?
Screening is discouraged for men under age 40 years due to the relatively low prevalence of clinically detectable prostate cancer in this age group, the absence of any evidence demonstrating benefits of screening, and the known harms of screening.
Does the panel recommend routine PSA screening for men between the ages of 40 to 54 years?
No, the panel does not recommend routine screening for men between the ages of 40 to 54 years who are at average risk.
What is the evidence for the benefits of PSA screening in men under the age of 55 years?
There is no high-quality evidence to support the benefits of PSA screening in men under the age of 55 years. The two large randomized clinical trials did not include men under the age of 55 years, so they do not inform the decision.
What is the reason for the panel’s recommendation against routine screening in men between the ages of 40 to 54 years?
The panel’s recommendation is based on the relatively low benefits and high harms of screening in this population. The harms of screening in this age group are at least equal to the benefits, if not higher.
Are there any subgroups of men who may benefit from earlier screening?
Yes, there may be subgroups of men who are at higher risk, such as African American men and those with a family history of metastatic or lethal adenocarcinomas. For such men, decisions regarding prostate cancer screening should be individualized.
Does the panel’s recommendation imply that there is absolutely no benefit to screening men between the ages of 40 to 54 years?
No, the panel’s recommendation does not imply that there is absolutely no benefit to screening this age group. It just means that the significant harms associated with screening likely outweigh the benefits.
What is the recommendation for men ages 55 to 69 years regarding PSA screening?
The Panel recommends shared decision-making for men ages 55 to 69 years that are considering PSA screening, and proceeding based on men’s values and preferences.
What is the benefit of PSA screening for men ages 55 to 69 years?
There is moderate evidence for the benefit of PSA screening in this age group, which includes a relative risk reduction of 21% in prostate cancer-specific death according to the ERSPC study at a median follow-up of 11 years.
What should be considered during the shared decision-making process for men ages 55 to 69 years considering PSA screening?
The shared decision-making process should consider the man’s individual life expectancy, baseline mortality risk from other co-morbid conditions, individual risk for prostate cancer given their race/ethnicity and family history, and the degree to which screening might influence their overall life expectancy and chance of experiencing morbidity from prostate cancer or its treatment.
What other approaches can be considered for prostate biopsy decisions in men with a suspicious PSA level?
Novel markers, imaging, and/or risk calculators can be considered for prostate biopsy decisions in men with a suspicious PSA level to inform biopsy decisions.
What is the guideline statement for screening interval in men who have decided on screening through shared decision-making?
The guideline statement for screening interval in men who have decided on screening through shared decision-making is that a routine screening interval of two years or more may be preferred over annual screening.