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The full report is titled “Screening for Prostate Cancer: A Guidance Statement From the Clinical
Guidelines Committee of the American College of Physicians.” It is in the 21 May 2013 issue of
Annals of Internal Medicine (volume 158, pages 761-769). The authors are A. Qaseem,
M.J. Barry, T.D. Denberg, D.K. Owens, and P. Shekelle, for the Clinical Guidelines Committee of the
American College of Physicians.
This article was published at www.annals.org on 9 April 2013.
Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of
the American College of Physicians. Ann Intern Med. 2013;158:I-28. doi: 10.7326/0003-4819-158-10-201305210-00634
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Published: Ann Intern Med. 2013;158(10):I-28.
The Clinical Guidelines Committee of the American College of Physicians (ACP) developed these guidelines.
ACP is a professional organization for internal medicine doctors, who are specialists in adult care.
Prostate cancer is the most commonly diagnosed nonskin cancer among men in the United States. The most
common prostate cancer symptoms are difficult or frequent urination, but many men have no symptoms.
A blood test that measures prostate-specific antigen (PSA) levels can find prostate cancer before symptoms
develop. If the PSA level is high, a prostate biopsy may be needed to see whether cancer is actually
present. A biopsy is a procedure that is done to obtain a piece of the prostate for examination.
Most prostate cancer grows slowly, and many men with prostate cancer die of something other than prostate
cancer. Currently, there is no way to know which cases of prostate cancer are life-threatening and require
treatment and which cases are not. When screening identifies cancer that is not life-threatening, men
experience unnecessary worry and complications from treatment. Common complications include urinary
incontinence and erectile dysfunction.
Organizations have guidelines for prostate cancer screening that provide different and conflicting advice.
ACP evaluated available guidelines to help doctors and patients make better decisions.
The National Guideline Clearinghouse (NGC) is a database developed by the U.S. government to make clinical
guidelines widely available. The authors searched the database for U.S. guidelines about prostate cancer
screening with PSA. They evaluated each guideline using a published instrument that considers 23 standard
criteria for the quality of guidelines and rated each guideline from 1 (worst) to 7 (best).
The authors found 4 guidelines: American College of Preventive Medicine, 2008 (rating of 3); American Cancer
Society, 2010 (rating of 5); American Urological Association, 2009 (rating of 3); and the U.S. Preventive
Services Task Force, 2012 (rating of 6).
They conclude that PSA is not just a blood test. It can open the door to more testing and treatment that a
man may not want or that may harm him. Because chances of being harmed are greater than chances of
benefiting, each man should have the opportunity to decide for himself whether to be screened.
Doctors should inform men aged 50 to 69 years about the limited potential benefits and substantial potential
harms of prostate cancer screening. Patients and doctors should base screening decisions on the patient's
preferences, prostate cancer risk, health, and life expectancy.
Doctors should not screen for prostate cancer using PSA unless patients express a clear preference for
screening after discussion.
Doctors should not screen using PSA in average-risk men younger than 50 years or older than 69 years, or any
man with a life expectancy less than 10 to 15 years.
These recommendations apply to men at average risk for prostate cancer who do not have symptoms that could
be caused by prostate cancer. The authors did not consider non-U.S. guidelines.
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Hematology/Oncology, Guidelines, High Value Care, Prostate Cancer, Cancer Screening/Prevention.
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