Guidelines suggest more informed consent for prostate cancer screening
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Better informed consent and personal decisions could lead to increased screening intervals for prostate cancer in some men, suggested new guidelines from the American Cancer Society.
New prostate cancer screening guidelines recommend that physicians discuss the pros and cons of testing, that digital rectal exams (DREs) be optional, and that previous prostate-specific antigen (PSA) tests should be used to guide informed consent and follow-up frequency, according to guidelines published online March 3 by CA: A Cancer Journal for Clinicians.
What hasn't changed:
- Men whose life expectancy is less than 10 years should not be screened for early detection of prostate cancer;Black men and those with a family history of earlier onset are at higher risk and should be offered informed decision making at an earlier age;PSA level of 4.0 ng/mL is a reasonable threshold for further evaluation.
The guidelines now state:
- PSA screening is recommended with or without DRE;Screening intervals can be extended to every two years for men whose PSA is less than 2.5 ng/mL;An individualized risk assessment that incorporates other risk factors for prostate cancer for PSA levels between 2.5 ng/mL and 4.0 ng/mL should be considered, particularly for those at risk for high-grade cancer.
Men at average risk should receive this information beginning at age 50. Black men and men with a father or brother diagnosed with prostate cancer before age 65 years should receive this information at age 45. Men with multiple family members diagnosed with prostate cancer before age 65 should receive this information beginning at age 40.
Because individuals use different values to balance the potential of lowering a man's probability of dying from cancer and the deleterious effects of treatment, the guidelines encourage clinicians and patients to use prostate cancer screening decision aids. If a man is unable to decide, the clinician can use discretion based on knowledge of the man's general health preferences and values.