Early Detection of Prostate Cancer: AUA Guideline

• Published in: The Journal of urology Vol. 190; no. 2; pp. 419 - 426
• Main Authors: Carter, H. Ballentine, Albertsen, Peter C, Barry, Michael J, Etzioni, Ruth, Freedland, Stephen J, Greene, Kirsten Lynn, Holmberg, Lars, Kantoff, Philip, Konety, Badrinath R, Murad, Mohammad Hassan, Penson, David F, Zietman, Anthony L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2013; Elsevier
• Subjects: Adult; Age Factors; Aged; Biological and medical sciences; Decision Making; early detection of cancer; Early Detection of Cancer - standards; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Mass Screening - standards; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; prostate-specific antigen; Prostate-Specific Antigen - blood; prostatic neoplasms; Prostatic Neoplasms - diagnosis; Risk Factors; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; digital rectal examination; FDA; RCT; prostate specific antigen; ERSPC; PLCO; randomized controlled trial; European Randomized Study of Screening for Prostate Cancer; Prostate Lung, Colorectal and Ovarian; early detection of cancer; DRE; prostatic neoplasms; Food and Drug Administration; prostate-specific antigen; PSA; Prostate tumor; Nephrology; Urinary system disease; Prostate disease; Early stage; Tumoral marker; Malignant tumor; Recommendation; Urology; Prostate specific antigen; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0022-5347; 1527-3792; 1527-3792
• DOI: 10.1016/j.juro.2013.04.119

Purpose The guideline purpose is to provide the urologist with a framework for the early detection of prostate cancer in asymptomatic average risk men. Materials and Methods A systematic review was conducted and summarized evidence derived from over 300 studies that addressed the predefined outcomes of interest (prostate cancer incidence/mortality, quality of life, diagnostic accuracy and harms of testing). In addition to the quality of evidence, the panel considered values and preferences expressed in a clinical setting (patient-physician dyad) rather than having a public health perspective. Guideline statements were organized by age group in years (age <40; 40 to 54; 55 to 69; ≥70). Results Except prostate specific antigen-based prostate cancer screening, there was minimal evidence to assess the outcomes of interest for other tests. The quality of evidence for the benefits of screening was moderate, and evidence for harm was high for men age 55 to 69 years. For men outside this age range, evidence was lacking for benefit, but the harms of screening, including over diagnosis and overtreatment, remained. Modeled data suggested that a screening interval of two years or more may be preferred to reduce the harms of screening. Conclusions The Panel recommended shared decision-making for men age 55 to 69 years considering PSA-based screening, a target age group for whom benefits may outweigh harms. Outside this age range, PSA-based screening as a routine could not be recommended based on the available evidence. The entire guideline is available at www.AUAnet.org/education/guidelines/prostate-cancer-detection.cfm.