All Willing Souls Can Do It                   
And We Can Help
                  
Email: realinct2002@yahoo.com                   
Dr. Lin's Quest beyond Medication and Surgery                 

    Prostate Cancer Screening Guidelines

    Screening for prostate cancer is highly controversial. This table summarizes some of the major and international medical groups
    recommendations in this area.

    =============================================================================================
    Organization (Year)  / Recommendation
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    American Cancer Society (ACS), 2010                    
         1. No routine screening; after informed discussion of risk and benefits for those who wish to be screened
           2. No screening with <10-yr life expectancy
           3. Screen with PSA, w/ or w/o DRE (digital rectal exam), at age 50 with >10-yr life expectancy; if PSA >2.5 ng/ml, screen yearly,
                otherwise screen every 2 yr
           4. Beginning screening discussions at age 40-45 if at high risk of developing prostate cancer (eg, black men, or with a first-degree
                relative with prostate cancer diagnosed before age 65).
           5. Biopsy referral threshold is 4 ng/ml. With PSA 2.5-4 ng/ml, encourage individualized decision making and assessment
                (http://deb.uthscsa.edu/URORiskCalc.jsp), which can include age, race, family history, DRE, previous biopsy results, and use of
                5-alpha reductase inhibitors.                                                                                    
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    American College of Physicians 2013               
    1. Inform men age 50-69 about limited benefits and harms; screen only if patient wants it
    2. Do not screen <age 50 if average risk, or <10-15-yr life expectancy
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    American Urological Association (AUA) 2013                
    1. No screening under 40; not recommended if average risk 40-54; individualize if high risk
    2. Shared decision making for age 55-69
    3. No screening over age 75 or any men <10-15-yr life expectancy some men over age 70 in excellent health might benefit from
    screening
    4. Reduce the harms of screening, a screening interval of 2-yr or more may be preferred.
    5. Lack of evidence for using any tests (eg, PSA derivatives, PSA kinetics, PSA molecular markers, urinary markers,  imaging, or risk
       calculations) other than PSA for triggering a biopsy referral. No specific threshold for biopsy referral.
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    Australian Cancer Council 2011
    1. Does not support population-based screening
    2. Recommends a patient-centered approach that individualizes the decision
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    Canadian Task Force on Preventive Health Care  (2006; 2014 Update pending       
    1. Recommend against screening for prostate cancer with PSA or TRUS (transrectal ultrasound)
    2. Insufficient evidence to recommend for or against screening with DRE
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    European Society for Medical Oncology (ERMO) 2013                                           
    1. Recommend against population-based screening; favors individualized shared decision making
    2. There is inconsistent evidence screning men <50 and 70-75 yr of age; evidence that the harms of screening outweigh the benefits for
       men over age 75
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    National Comprehensive Cancer Network (NCCN) 2014    
    1. Informed discussion with all
    2. Baseline DRE and PSA age 45; if PSA <1, repeat age 50; if PSA >1, repeat every 1-2 yr                                 
    3. Age 50-70 with normal DRE and PSA <3, repeat every 1-2 yr
    4. Use caution screening if >age 70 and only if very healthy; few >age 75 benefit from screening
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    United Kingdom National Screening Committee 2010
    1. Does not recommend screening for prostate cancer
    -----------------------------------------------------------------------------------------------------------------------------------------------------
    United States Preventive Services Task Froce (USPSTF) 2012
    1. No role in any men unless symptoms (grade D)
    2. Men requesting screening be supported in making an informed decision.
    =============================================================================================
    Notes: All PSA values are ng/ml.
    Risks:  1. African American or have a 1st-degree relative diagnosed with prostate cancer (PCa) at <65 yr of age.
                 2. Several 1st-degree relatives diagnosed with PCa at <65 yr of age.
                 3. Positive family history or African American race.

    Modified from Gomella LG, et al. CIU. 2011; 18(5):5875; ACP 2013 guidelines (www.acponline.org); NCCN 2014
    Prostate Cancer  Guidelines  Version 1.2014 (www.nccn.org); Hoffman RM; Screening for Prostate Cancer update.com
    (Accessed August 31, 2014)
    =============================================================================================
    Dr. Lin's comments:
    Realize the fact that every life event is always a process of lifelong making and always displays itself along its pattern
    of full spectrum; at its very early stage, it may be very mild and elusive, and hard to tell what it may be; toward its late
    full-blown stage, obvious and easy to tell what it is. This situation in life reality applies to interpret PSA values and
    DRE finding.

    Besides, interpreting the findings of digital rectal exam (DRE) is very subjective reflecting examiner's professional
    keenness and acuity - attesting all professionals on white coats only mean they earned diploma, carry license and a
    stack of training certificates, but do not bear same professional capacity.
                                                  
                                           
Copyright is preserved. Copying is prohibited without author's permission.
Copyright is preserved. Copying is prohibited without author's permission.
Copyright is preserved. Copying is prohibited without author's permission.
Copyright is preserved. Copying is prohibited without author's permission.
PSA / its Use, Prostate
Cancer / its Care...
www.ForMeFirst.com  
Universal Healthy Lifestyle
Roadmap to Long Happy Life
Since 1998