Published online Aug 12, 2014. doi: 10.5528/wjtm.v3.i2.112
Revised: June 24, 2014
Accepted: July 25, 2014
Published online: August 12, 2014
The updated United States Preventive Services Task Force (USPSTF) for prostate cancer in 2012 recommends against prostate-specific antigen (PSA) based screening for men of all ages. Prostate cancer is the second most common and second most deadly cancer in American men. PSA screening for prostate cancer has been present since 1994 leading to an over diagnosis and over treatment of low volume disease. There is an overall agreement of men towards the guidelines but even with the understanding of the USPSTF, these men tend to follow more personal beliefs that have been influenced by their knowledge of the disease process and physician influence. Physicians also followed the directions of the patients and opted not to change their current practice of PSA screening despite the new guidelines. Time, legal, and ethical issues were some of the barriers that physicians faced in tailoring their practice towards screening. The importance of informed consent is highlighted by both the patients and the physicians and clearly more effective when the patient was pre-informed of the disease process and prompted the physicians to initiate conversation of informed screening. Younger patients were inclined towards aggressive treatment and older patients opted towards watchful waiting both with emphasis on the importance of evidence-based information provided by the physician. Decision aids were useful in making informed decisions and could be used to educate patients on screening purposes and treatment options. However, even with well-created decision aids and physician influence, patients’ own belief system played a major part in healthcare decision making in either screening or treatment for prostate cancer.
Core tip: Prostate cancer screening has never been more controversial since publication of large randomized trials showing conflicting results with some demonstrating beneficial mortality effects from the European trials but the American screening trial showing no mortality benefit. At the core of the prostate cancer screening debate is not only the overdiagnosis, but rather over-treatment of men with low-risk prostate cancer. This review explores the literature regarding these patterns of screening especially post publication of the United States Preventive Services Task Force guidelines. The use of enhanced risk-adapted approach, perhaps with decision aids, may serve as useful tools to help in the decision for continued screening for men who would benefit.