This is common in a series excerpt...

This is common in a series excerpted from the Recommendations and Rationale Statements released on the current U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening examples counseling, and chemoprevention. The total statement is available in HTML and PDF formats by the and of the AFP Web site at www.aafp. org/afp/20030215/us. html This statement is part of AFP's CME descry "Clinical Quiz" on page 691

This is the present U.S. Preventive Services Task Force (USPSTF) recommendation in succession screening for prostate cancer and the supporting scientific evidence. It updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, next to the first edition. (1) Explanations of the ratings and of the puissance of overall evidence are given in Tables 1 and 2 respectively. The total information on which this statement is based, including evidence tables and concerns is available in the summary of the evidence and in the systematic evidence review (2) onward this topic, which can be obtained by the and of the USPSTF Web site (www preventiveservices.ahrq.gov). The recommendation statement and summary of the evidence also are available in print by the and of the AHRQ Publications Clearinghouse (1-800-358-9295; e-mail: ahrqpubs@ahrq.gov).

Summary of Recommendation

* The USPSTF gather s that the evidence is insufficient to praise for or against routine screening for prostate cancer using prostate-specific antigen (PSA) testing or digital rectal examination (DRE) I recommendation.

The USPSTF fix good evidence that PSA screening can discover early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health issues Screening is associated with important harms, including of frequent occurrence false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of any cancers that may never have affected a patient's health. The USPSTF finishs that evidence is insufficient to determine whether the benefits outweigh the harms for a shielded population.

Clinical Considerations

* PSA testing and DRE can effectively ascertain prostate cancer in its early pathologic stages. late evidence suggests that radical prostatectomy can diminish prostate cancer mortality in men whose cancer is discovered clinically. The balance of potential benefits (the reduction of morbidity and mortality from prostate cancer) and harms (false-positive rises unnecessary biopsies, and possible complications) of early treatment of the symbols of cancers found by screening, however, remains uncertain. Therefore, the benefits of screening for early prostate cancer remain unknown. Ongoing screening trials, and trials of treatment versus "watchful waiting" (deferring treatment until symptoms or disease progression is evident) for cancers lay opened by screening may help clarify the benefits of early detection of prostate cancer.

* Despite the absence of firm evidence of effectiveness, near clinicians may opt to perform prostate cancer screening for other reasons. Given the uncertainties and process in law surrounding prostate cancer screening, clinicians should not order the PSA touchstone without first discussing with the patient the potential yet uncertain benefits and the possible harms of prostate cancer screening. Men should be informed of the gaps in the evidence, and they should be assisted in considering their personal choices and risk profile before deciding whether to be tested

* If early detection improves health results the population most likely to benefit from screening will be men aged 50 to 70 who are at average risk, and men older than 45 who are at increased risk (African-American men and men with a family history of a first-degree relative with prostate cancer).3 Benefits may be smaller in Asian Americans, Hispanics, and other racial and ethnic clusters that have a lower risk of prostate cancer. Older men and men with other significant medical question s who have a life expectancy of fewer than 10 years are unlikely to benefit from screening. (3)

* PSA testing is more sensitive than DRE for the detection of prostate cancer. PSA screening with the conventional cut-point of 40 ng for mL detects a large majority of prostate cancers; however, a significant percentage of early prostate cancers (10 to 20 percent) will be missed by means of PSA testing alone. (2) Using a lower gate to define an abnormal PSA lay opens more cancers at the sumptuousness of more false-positives and more biopsies.

* The yield of screening in confines of cancer detected declines rapidly with repeated annual testing. (3) If screening were to decrease mortality, biennial PSA screening could yield as a great deal of benefit as annual screening.

Scientific Evidence

EPIDEMIOLOGY AND CLINICAL CONSEQUENCES

Prostate cancer is the other leading cause of cancer-related death among men in the United States (second to lung cancer). (3) In 2002 an estimated 189000 recently made known cases of prostate cancer will be diagnosed in American men and approximately 30200 men will die from the disease. (4) The risk of developing prostate cancer increases beginning at age 40 The probability of developing prostate cancer athwart the next 10 years is 017 percent for men aged 40 201 percent for men aged 50 and 646 percent for men aged 60 (5)