Targeted PSA screening prevents overdiagnosis, overtreatment

Offer PSA screening only to men with a reasonable life expectancy.
Offer PSA screening only to men with a reasonable life expectancy.

NEW ORLEANS — Screening for prostate-specific antigen should move from a population-based standard to more targeted efforts, according to a poster presentation at the American Association of Nurse Practitioners 2015 meeting.

Outlining some potential strategies based on large screening studies and guidelines from major medical organizations, Susanne Quallich, ANP-BC, NP-C, CUNP, FAANP, a certified nurse practitioner in the Division of Andrology and Urologic Health in the University of Michigan Health System in Ann Arbor, suggested providers consider the following:

  • Offer prostate-specific antigen (PSA) screening only to men with a reasonable life expectancy (greater than 10 years) — a longer life expectancy shows greater benefit of detection based on the most recent research
  • Screen every other year or less frequently, based on individual patient risk, to minimize over diagnosis
  • Use other data (e.g., PSA kinetics, body mass index) to adjust screening intervals and referral thresholds for prostate biopsy
  • Make sure patients are well-informed about the possibly limited benefit and associated harms of early detection and treatment of prostate cancer.

There continues to be a lack of consensus among medical organizations on PSA screening that makes it difficult from a primary care standpoint to decide when screening should begin, Quallich said. 

“I would recommend that primary care providers find out what are the prevailing set of guidelines in their community is following, even outside of the urology practices and follow those guidelines, so that they are at least in line with what's going on in their community,” she said.

Quallich's presentation reviewed results from the Göteborg screening study (Godtman RA, et al. European Urology. Published online ahead of print, January 1, 2015), European Randomized Study of Screening for Prostate Cancer (Heijnsdijk EA, et al. Journal of the National Cancer Institute. 2014;107(1):366), and Prostate, Lung, Colorectal, and Ovarian Cancer screening trial (Grubb RL, et al. European Urology. Published online ahead of print, May 7, 2015). 

Her poster presented the guidelines issued by the American Cancer Society in 2010, U.S. Preventive Services Task Force in 2012, American Urological Association in 2013, European Association of Urology in 2013, American College of Physicians in 2013, and National Comprehensive Cancer Network in 2014.

Although there is a very high rate of diagnosis (estimated at 87% to 94%), Quallich argued that early diagnosis of clinically relevant prostate cancer can lower mortality, especially within certain populations.

“PSA screening has gone from generalized population screening to targeted screening,” she said. “Targeted screening is more cost-effective and should prevent some of the over diagnosis and over treatment that we've seen with prostate cancer in the past.”

Reference

  1. Quallich SA. Poster session. Presented at: AAPA 2015. June 10-14; New Orleans.
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