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ACP: Discuss prostate screening with men 50-69 years old

Clinical Question:
According to the American College of Physicians, who should be screened for prostate cancer?

Bottom Line:
Joining the parade of groups urging caution about indiscriminate screening for prostate cancer using prostate-specific antigen testing, the American College of Physicians (ACP) offers a guidance statement that only men aged 50 years to 69 years should be screened, and only after a discussion of the risks and benefits during which the patient expresses a "clear preference" for screening. Men of average risk who are younger than 50 years or older than 69 years should not be screened. (LOE = 5)

Reference:
Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2013;158(10):761-769.  [PMID:23567643]

Study Design:
Practice guideline

Funding:
Government

Setting:
Various (guideline)

Synopsis:
Rather than start from scratch, the ACP is taking the approach of evaluating guidelines produced by other groups, in this case the American College of Preventive Medicine, the American Cancer Society, the American Urological Association (whose guidelines have been updated since this report), and the United States Preventive Services Task Force. They used the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE II) instrument to evaluate the guidelines, which is limited in its approach but evaluates the clarity of guidelines and the steps taken in their development. From this appraisal the ACP developed 2 guidance statements: (1) Men between 50 years and 69 years of age should be informed about "the limited potential benefits and substantial harms" of screening for prostate cancer. The decision of whether to screen should be determined based on the patient's risk, a discussion of the benefits and harms, the patient's general health and life expectancy, and patient preferences. Men who do not express a "clear preference" should not be screened. (2) Men at average risk should not be screened if they are younger than 50 years or older than 69 years, or if they have a life expectancy of fewer than 10 to 15 years.

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