Prevention, Screening and Health Maintenance
Family Medicine Clerkship
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Prostate Cancer
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Prostate Cancer Screening

What are the current recommendations for prostate cancer screening?

US Preventive Services Task Force:

• There is no current evidence to support annual PSA testing and DRE examinations for men over 50 years of age.
• This does not mean that men with possible symptoms of prostate cancer should not be tested.
• It does mean that a large sector of the medical community will not endorse annual PSA tests and DREs for asymptomatic males.

American College of Physicians:

• Recommendation 1: Rather than screening all men for prostate cancer as a matter of routine, physicians should describe the potential benefits and known harms of screening, diagnosis and treatment; listen to the patient's concerns; and then individualize the decision to screen.
• Recommendation 2: The College strongly recommends that physicians help enroll men in ongoing studies.

American Urological Association:

• All males of 50 years or more should have an annual prostate examination comprising a digital rectal examination and a PSA test.
• All males of 40 years or more with a family history of prostate cancer should have an annual prostate examination comprising a digital rectal examination and a PSA test.

American Cancer Society:

• Beginning at age 50, an annual prostate examination, including a digital rectal examination and a PSA test, should be offered annually to men who have a life expectancy of at least 10 years, and to younger men who are at high risk

Is there a suvival advantage for early screening of prostate cancer?

• There is controversy as to what is an appropriate treatment strategy for cancer prostate.
• There is one view that treatment modalities do not have a proven survival advantage.
• Hence it is difficult to come up with a recommendation for population screening.

What is the role of imaging procedures in prostate cancer screening?

• Transrectal prostate ultrasound has been considered by some to be a potentially useful screening modality.
• Among other radiologic modalities (i.e. CT and MRI), ultrasound has a better potential for screening utility.
• Disadvantages include low sensitivity (71% to 92% for cancer and 60% to 80% for subclinical disease) and specificity (49% to 79%).
• Positive predictive value was also found to be relatively low at 30%.
• As a single test for the screening of prostate cancer, ultrasound has a very low yield.
• However, when used as a diagnostic exam in the presence of a positive PSA or DRE, the yield is much better.
• Ultrasound does not play any role, at this time, in screening for prostate cancer.
• Bottom line: ultrasound is not good for screening, but is helpful for workup of suspected prostate cancer.