Prostate cancer screening entails the performance of the prostate-specific test (PSA) capable of detecting cancer in its early stages. Notable cons for PSA test are a false-positive test that leads to misdiagnosis and true positive test that results in diagnosis in patients who would have never had symptoms of cancer in their lifetime (Gonzalez, 2019). Both testing and treatment process exposes victims to a high level of radiation that cause damaging side effects. The most common side effects of the radiation are hematospermia, urinary and bowel incontinence, erectile dysfunction and impotence (Cheuck, 2019). The side effects have led to the establishment of guidelines that help in decision making when testing is a consideration. Discussed herein are the American Cancer Society (ANC) and the American Urological Association (AUA) guidelines.
The ANC guidelines grant freedom to anyone with a life expectancy of more than ten years to decide whether or not to take the test upon being educated on the effects of the screening process (Wolf et al., 2010). The AUA guidelines give similar directives but its life expectancy restriction is fixed at not less than 10 to 15 years.
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In the ANC guidelines, considerations for screening is based on age and risk factor for developing prostate cancer. The three age groups with a preference towards taking the PSA test are persons at age 40 years having at least two immediate family members diagnosed with cancer at a similar age and persons at age 45 years with at least one immediate family member diagnosed with the similar condition at 64 years or lower. The last age group is persons age 50 years with average risk (Wolf et al., 2010). Similarly, AUA recommends against anyone below 40 years from taking the tests. The association is also against routine checks for persons aged 40 to 54 years but recommends an individualized approach when risks are higher. AUA recognizes the age bracket of 55 to 69 as being prone but suggests a deliberation on pros and cons before screening and diagnosis (American Urological Association, 2013). The most vulnerable age bracket as per the ANC is 50 to 69 years while AUA puts it at 55 to 69 years. Both ANC and AUA recommend against the testing of persons above 69 years and below 40 years. However, the AUA guidelines have a softer stance on men above 70 years who are in excellent health thus allowing them to take up screening.
On routine testing, the AUA strictly recommends against repeated testing for persons at age 40 t0 54 years. The ANC, however, allows routine testing based on the PSA test outcomes. It suggests that persons with a PAS test result of less than 2.5ng/ml may retest after every two years while those with a PSA test result equal to or greater than 2.5ng/ml should undergo screening annually (Wolf et al., 2010).
Whereas adherence to screening guidelines would help avert numerous side effects caused by radiation, several studies continue to point out at global lapses in this area. Strumpf, Chai, and Kadiyala (2010) conduct an observational study in Canadian provinces and discover that screening rates are high with no correlation to the age groups specified in the guidelines. In their conclusion, they recon at the low compliance levels and recommend a reduction in screening rates in younger groups and increase of rates in the right age groups (Strumpf, Chai, & Kadiyala, 2010). In a different but related study, researchers conclude that lack of knowledge is the cause of noncompliance with screening guidelines. Among those interviewed, only 22% show accurate knowledge concerning age brackets of those prone to cancer and those with a lower risk of suffering from cancer. They recommend strengthened initiatives from the public and health institutions on educating the masses to improve knowledge and compliance on cancer screening guidelines (Lofters, Telner, Kalia, & Slater, 2018)
References
American Urological Association. (2013). Early detection of prostate cancer . Retrieved from https://www.auanet.org/guidelines/prostate-cancer-early-detection-guideline
Cheuck, L. (2019, January 14). Prostate Cancer Diagnosis and Staging: Practice Essentials, Overview, Relevant Anatomy. Retrieved November 19, 2019, from https://emedicine.medscape.com/article/458011-overview#a6
Gonzalez, C. (2019, November 19). Update on Prostate Cancer Screening Guidelines. Retrieved November 20, 2019, from https://www.medscape.com/viewarticle/766698_7
Lofters, A. K., Telner, D., Kalia, S., & Slater, M. (2018). Association Between Adherence to Cancer Screening and Knowledge of Screening Guidelines: Feasibility Study Linking Self-Reported Survey Data With Medical Records. JMIR Cancer , 4 (2), e10529. doi:10.2196/10529
Strumpf, E. C., Chai, Z., & Kadiyala, S. (2010). Adherence to cancer screening guidelines across Canadian provinces: an observational study. BMC Cancer , 10 (1). doi:10.1186/1471-2407-10-304
Wolf, A. M., Wender, R. C., Etzioni, R. B., Thompson, I. M., D'Amico, A. V., Volk, R. J., … Smith, R. A. (2010). American Cancer Society Guideline for the Early Detection of Prostate Cancer: Update 2010. CA: A Cancer Journal for Clinicians , 60 (2), 70-98. doi:10.3322/caac.20066
