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CLINICAL GUIDELINE: PART III: Screening for Prostate Cancer
- American College of Physicians*. *This paper, written by Christopher M. Coley, MD, Michael J. Barry, MD, and Albert G. Mulley, MD, MPP, was developed for the Health and Public Policy Committee by the Clinical Efficacy Assessment Subcommittee: George E. Thibault, MD, Chair; John R. Feussner, MD, Co-Chair; Anne-Marie J. Audet, MD; Gottlieb C. Friesinger Jr., MD; Daniel L. Kent, MD; Keith I. Marton, MD; Valerie Anne Palda, MD; John J. Whyte, MD; and Preston L. Winters, MD. This paper was approved by the Board of Regents on 10 February 1996. Note: The Clinical Efficacy Assessment Project (CEAP) of the American College of Physicians is designed to evaluate and inform College members and others about the safety and efficacy of diagnostic and therapeutic modalities. Requests for Reprints: Customer Service Representative, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.
Prostate cancer, which caused an estimated 40 000 deaths and substantial aggregate illness in 1995, is now the most commonly diagnosed type of cancer among men in the United States [1]. However, whether early detection of this disease generally does more good than harm is a matter of controversy [2-8]. As a result, conflicting recommendations have been issued by various professional organizations [6-8]. The debate is fueled by the absence of evidence from controlled studies showing that screening reduces mortality related to prostate cancer. Moreover, the degree to which radical prostatectomy or radiation therapy for clinically localized prostate cancer improves life expectancy, aggregate morbidity, or overall quality of life for the typical patient is uncertain. Several ongoing trials of early detection and treatment should eventually answer these questions [9-12]. However, because of the slow progression of most cases of prostate cancer, the results of these trials are not expected for at least a decade. In addition, differences among available professional recommendations appear to derive largely from differences in the level of evidence that each group requires to advocate screening [6-813, 14].
The purpose of this guideline is to 1) clarify what is known about the potential benefits and risks associated with early detection and treatment of prostate cancer and 2) assist physicians in helping patients make an informed decision about whether to be screened for prostate cancer.
Screening Test or Diagnostic Test?
The traditional distinction between a screening test and a diagnostic test can seem blurred when testing for prostate cancer. Screening involves testing persons who have no symptoms of the condition in question. The purpose of screening is to detect disease early, when treatment might be more effective or less expensive. However, about one third of men who are older than 50 years of age have lower urinary tract …
