Prostate cancer screening with prostate-specific antigen (PSA) test: A clinical practice guideline
Tikkinen, Kari A.O.; Dahm, Philipp; Lytvyn, Lyubov; Heen, Anja Fog; Vernooij, Robin W.M.; Siemieniuk, Reed A.C.; Wheeler, Russell; Vaughan, Bill; Fobuzi, Awah Cletus; Blanker, Marco H.; Junod, Noelle; Sommer, Johanna; Stirnemann, Jérôme; Yoshimura, Manabu; Auer, Reto; MacDonald, Helen; Guyatt, Gordon; Vandvik, Per Olav; Agoritsas, Thomas
Peer reviewed, Journal article
Published version
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https://hdl.handle.net/11250/2659455Utgivelsesdato
2019Metadata
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Sammendrag
What is the role of prostate-specific antigen (PSA) screening in prostate cancer? An expert panel produced these
recommendations based on a linked systematic review.1
The review was triggered by a large scale, cluster randomised trial on PSA screening in men without a previous
diagnosis of prostate cancer published in 2018 (box 1).2
It
found no difference between one-time PSA screening and
standard practice in prostate cancer mortality but found
an increase in the detection of low risk prostate cancer
after a median follow-up of 10 years.
Although the results of this study suggest screening
is not worthwhile, several guidelines advocate offering
screening in some cases. The study was much larger than
previous studies, and existing trials had published more
extended follow-up results, and the BMJ Rapid Recommendations team felt these merited a new appraisal of
the body of evidence. This guideline aims to promptly
and transparently translate potentially practice-changing
evidence to usable recommendations for clinicians and
patients, based on the GRADE framework and following
standards for trustworthy guidelines.
The panel suggests against systematic PSA screening
(weak recommendation). The panel members judged that
most men will decline screening because the benefit is
small and uncertain and there are clear harms. However,
there is likely considerable variation in values and preferences. Men with family history of prostate cancer, African
descent or of lower socioeconomic status, having higher
baseline risk of prostate cancer death, may be more likely
to choose PSA screening. Shared decision-making is
needed for men considering screening.
Box 2 shows all of the articles and evidence linked in
this Rapid Recommendation package. The main infographic provides an overview of the absolute benefits
and harms of PSA screening. The table at the end of the
article shows any evidence that has emerged since the
publication of this guideline.