A recent article published in the International Journal of Clinical Practice, has explored the dilemma of when to screen prostate cancer patients. The authors provide guidance and their own perspective on how to involve patients in these shared decisions.
Currently, screening is debated among primary care providers: some guidelines suggest that there is a lack of evidence to support testing the general population, while other guidelines state that screening is effective in certain patient populations.
Matt Rosenberg, lead author of Mid Michigan Health Centers (MI, USA), commented: “The primary care provider is on the front line with regards to early detection of prostate cancer. In fact, they are responsible for 90% of the labs drawn in screening. Getting rid of the evaluation for prostate cancer altogether is a bad idea, but intelligently using the tools we have is certainly within the best interest of our patients.”
In the article, the authors suggest that it is vital to screen the appropriate patients i.e. those who are aged 45 years and over with a life expectancy of 10 years. These men should be screened with both a digital rectal exam (DRE) and prostate-specific antigen test (PSA), and patients should be educated at the same time on the use of these tools.
The authors continue stating that primary care providers should consider a 5-year screening interval if the DRE is normal and the PSA is less than 1.5 ng/ml. However, if the DRE is abnormal the provider should refer the patient to a specialist. Likewise, if the PSA is 1.5 ng/ml or greater the patient should be referred, or a biomarker should be considered to assess risk.
Biopsies should only be conducted in patients thought to be at significant risk of aggressive forms of prostate cancer.
While the primary care provider remains to be a gatekeeper for prostate cancer screening, faced with numerous recommendations, the authors exemplify the importance of objective discussion for optimizing management decisions in these patients.
Sources: Rosenberg MT, Spring AC, Crawford ED. Prostate cancer and the PCP: the screening dilemma. Int. J. Clin. Pract. DOI: 10.1111/ijcp.12745. (2015); Wiley press release