Guidelines for Physicians Regarding Prostate Cancer Screening report by Dr. Peter Grimm for the King County Medical Society
Prostate cancer (PC) is the second leading cause of cancer-related mortality in men, with approximately 28,000 deaths per year. Screening for PC with the prostate-specific antigen (PSA) test carries some controversy, and patient questions arise about how to interpret the test results, as well as what can be done to mitigate the risk.
- The Controversy Over Screening
- Risk Factors
- We know that genetics, race and age are contributing factors.
- Who Should Be Screened, and When?
- What Tests?
- If Tests Are Abnormal, What Next?
- PSA Value and Risk of Prostate Cancer
- When to Refer a Patient
- A Positive DRE is an Indication for a Referral Regardless of PSA
Key Information for Patients About Screening
- Screening with the PSA blood test detects cancer at an earlier stage than if no screening is performed.
- Prostate cancer screening might be associated with a reduction in the risk of dying from prostate cancer; however, evidence is conflicting.
- For men whose prostate cancer is detected by screening, it is not currently possible to predict which men are likely to benefit from treatment.
- Treatment for prostate cancer can lead to urinary, bowel, sexual, and other health problems that can be significant or minimal, permanent or temporary.
- The PSA and DRE can produce falsepositive or false-negative results.
- Abnormal results from screening with PSA and DRE require prostate biopsies, which can be painful and lead to complications like infection or bleeding.
- Not all men whose prostate cancer is detected through screening require immediate treatment. Some require periodic blood tests and prostate biopsies to determine the need for future treatment.
Source: CA Cancer J Clin. Published online March 3, 2010
First published in the King County Medical Society The Bulletin (September/October 2010).