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Guideline Summary
Guideline Title
American Cancer Society guideline for the early detection of prostate cancer.
Bibliographic Source(s)
Wolf AM, Wender RC, Etzioni RB, Thompson IM, D'Amico AV, Volk RJ, Brooks DD, Dash C, Guessous I, Andrews K, DeSantis C, Smith RA, American Cancer Society Prostate Cancer Advisory Committee. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010 Mar-Apr;60(2):70-98. [154 references] PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This guideline updates previous versions:

Recommendations from the American Cancer Society Workshop on Early Prostate Cancer Detection, May 4-6, 2000 and ACS guideline on testing for early prostate cancer detection: update 2001. CA Cancer J Clin 2001 Jan-Feb;51(1):39-44.

Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 2003 Jan-Feb;53(1):27-43.

Each year the American Cancer Society publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer.

Scope

Disease/Condition(s)

Prostate cancer

Guideline Category
Counseling
Diagnosis
Risk Assessment
Screening
Clinical Specialty
Family Practice
Internal Medicine
Oncology
Preventive Medicine
Urology
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Health Plans
Hospitals
Managed Care Organizations
Nurses
Patients
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)
  • To update the 2001 American Cancer Society guideline pertaining to prostate cancer screening
  • To address:
    • Recommendations to providers and patients regarding offering screening to average risk men
    • Recommendations to providers and patients regarding screening higher risk men, principally African American men and men with one or more first-degree relatives with prostate cancer
    • Recommendations regarding the most appropriate screening test or combination of tests and periodicity if a man chooses to undergo screening
    • Recommendations regarding the advisability, nature, and content of shared decision-making discussions between men and health care professionals
Target Population

Men who have at least a 10-year life expectancy, including:

  • Men age 50 years and older who have an average risk for prostate cancer
  • Men age 45 years and older who have a higher risk for prostate cancer, including African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer before age 65 years
  • Men age 40 years and older who have an appreciably higher risk for prostate cancer (multiple family members diagnosed with prostate cancer before age 65 years)
Interventions and Practices Considered
  1. Information provided to patients about the uncertainties, risks, and potential benefits associated with prostate cancer screening
  2. Informed and shared decision making by patient in partnership with a health care provider about whether to be screened for prostate cancer
  3. Age thresholds for discussing prostate cancer screening with patients, depending on patients risk factors
  4. Assessment of life expectancy based on age and co-morbid conditions to assure suitability for screening prior to initiation of a screening discussion
  5. Use of patient decision-making aids
  6. Essential elements for programs offering screening outside of a direct clinician/patient relationship
  7. Prostate-specific antigen (PSA) blood test
  8. PSA velocity
  9. PSA blood test and digital rectal examination (DRE)
  10. Screening intervals of 1 or 2 years, depending on PSA levels
  11. Individualized risk assessment for referral for biopsy, if indicated

Note: Screening of men who are unlikely to survive for at least 10 years was considered but not recommended.

Major Outcomes Considered
  • Morbidity and mortality related to prostate cancer
  • Incidence of prostate cancer
  • Test positivity, cancer detection rates, sensitivity, specificity, and positive predictive value of screening procedures
  • Knowledge, decisional conflict, and role preference of patient in making screening decisions
  • Protective effect of screening
  • Risks and adverse effects of screening and diagnostic procedures
  • Number of tests and unnecessary biopsies
  • Rates of overdiagnosis and overtreatment
  • Risks and adverse effects of treatments

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

The process began by commissioning a series of systematic evidence reviews. The three broad content areas included early detection of prostate cancer, harms of therapy for localized prostate cancer, and shared and informed decision making in prostate cancer screening.

Within the domain of early detection of prostate cancer, search strategies addressed the following subdomains: 1) efficacy of screening in reducing mortality from prostate cancer; 2) test characteristics of prostate cancer screening in asymptomatic men, including sensitivity, specificity, and predictive value; and 3) physical and psychological harms associated with screening. Abstracted information included the study setting and design, screening test, participant characteristics (including age, race/ethnicity, educational status, and socioeconomic status), study arms (e.g., case and control definitions), proportion of participants screened, follow-up duration, confirmatory tests, outcome measures (e.g., mortality), and measure of associations (e.g., hazard ratios). For the subdomain of screening harms, information on methods used for measuring harms (e.g., anxiety questionnaire, general psychological distress/mental state questionnaire) was abstracted.

Searches related to the harms of treating clinically localized prostate cancer were limited to radical prostatectomy, external-beam radiation therapy, brachytherapy, androgen-deprivation therapy, watchful waiting, and active surveillance. The search strategy related to informed and/or shared decision making (IDM/SDM) for prostate cancer screening identified intervention studies that targeted asymptomatic men without a diagnosis of prostate cancer. The following designs were considered eligible for inclusion as intervention studies: randomized controlled trials, randomized controlled trials with preintervention and postintervention, preintervention and postintervention with control, and preintervention and postintervention without control. Extracted IDM/SDM outcomes were categorized as 1) knowledge, 2) screening rates, 3) screening intention, 4) decisional conflict, 5) decisional confidence, 6) decisional anxiety, 7) decision/role preferences, 8) satisfaction, and 9) other.

Studies were identified by searching Medline for articles that were published between January 1950 and June 2009. The initial searches were not limited to a specific study design. Review articles and congress abstracts also were searched for relevant articles. Two authors independently reviewed titles, abstracts, and full texts for eligibility and independently abstracted data from selected publications.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence

When appropriate, data were stratified based on patient characteristics, such as age, race, and positive family history of prostate cancer. Data were entered into a custom database that was developed specifically for this review using Microsoft Access Software 2007 (Microsoft Corporation, Redmond, WA). Any discrepancies in the study selection and data abstraction process were resolved through discussion by two authors.

The results of the systematic reviews were provided to all members of the American Cancer Society (ACS) Prostate Cancer Advisory Committee for review before meeting and were supplemented with presentations by experts (both committee members and invited outside experts) at a face-to-face meeting of the committee.

Deliberations about the evidence occurred at the committee meetings and in a series of conference calls that preceded and followed the meeting. Relevant literature that was not captured by the systematic reviews was disseminated by individual committee members to the entire committee.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

The American Cancer Society Prostate Cancer Advisory Committee developed the prostate cancer early detection guideline by consensus, and a writing committee drafted a guideline document, which was circulated to the entire committee for review and revision.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

The guideline with the supporting document was circulated to peer reviewers for feedback and then to the American Cancer Society (ACS) Mission Outcomes Committee for review. The Mission Outcomes Committee approved the guideline, suggested modifications to the supporting document, and forwarded the documents to the American Cancer Society Board of Directors for final approval.

Recommendations

Major Recommendations

Early Prostate Cancer Detection

The American Cancer Society (ACS) recommends that asymptomatic men who have at least a 10-year life expectancy should have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risks, and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information beginning at age 50 years. Men at higher risk, including African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer before age 65 years, should receive this information beginning at age 45 years. Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65 years) should receive this information beginning at age 40 years. Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources. Patient decision aids are helpful in preparing men to make a decision whether to be tested. For men who are unable to decide, the screening decision can be left to the discretion of the health care provider, who should factor into the decision his or her knowledge of the patient's general health preferences and values.

Asymptomatic men who have less than a 10-year life expectancy based on age and health status should not be offered prostate cancer screening. At age 75 years, only about half of men have a life expectancy of 10 years or more. Men in this age group with significant comorbidities, as well as younger men with life-limiting comorbid conditions, are not likely to benefit from screening. For example, men with New York Heart Association Class 4 congestive heart failure, moderate-to-severe chronic obstructive pulmonary disease, end-stage renal disease, moderate to severe dementia, or life-limiting cancer would not be expected to benefit from screening. Life-limiting comorbid conditions become more common as men age; thus, it is important to consider overall health status—not age alone—when making decisions about screening.

Core elements of the information to be provided to men to assist with their decision include the following (please refer to discussion in the original guideline document for more detailed, quantitative information related to each of these core elements):

  • Prostate cancer is an important health concern for men.
  • Screening with the prostate-specific antigen (PSA) blood test alone or with both PSA and digital rectal examination (DRE) detects cancer at an earlier stage than if no screening is performed.
  • Prostate cancer screening may be associated with a reduction in the risk of dying from prostate cancer; however, evidence is conflicting and experts disagree about the value of screening.
  • For men whose prostate cancer is detected by screening, it is not currently possible to predict which men are likely to benefit from treatment; some men who are treated may avoid death and disability from prostate cancer, whereas others who are treated would have died from unrelated causes before their cancer became serious enough to affect their health or shorten their lives. 
  • Depending on the treatment selected, treatment for prostate cancer can lead to urinary, bowel, sexual, and other health problems. These problems may be significant or minimal, permanent or temporary.
  • The PSA and DRE may produce false-positive or false-negative results, meaning that men without cancer may have abnormal results and get unnecessary additional testing, and clinically significant cancers may be missed. False-positive results can lead to sustained anxiety about prostate cancer risk.
  • Abnormal results from screening with the PSA or DRE require prostate biopsies to determine whether or not the abnormal findings are cancer. Biopsies can be painful, may lead to complications like infection or bleeding, and can miss clinically significant cancer.
  • Not all men whose prostate cancer is detected through screening require immediate treatment, but they may require periodic blood tests and prostate biopsies to determine the need for future treatment.

In helping men to reach a screening decision based on their personal values, once they understand the uncertainties, risks, and potential benefits, it can be helpful to provide reasons why some men decide for or against undergoing screening. For example:

  • A man who chooses to be screened might place a higher value on finding cancer early, might be willing to be treated without definite expectation of benefit, and might be willing to risk injury to urinary, sexual, and/or bowel function.
  • A man who chooses not to be screened might place a higher value on avoiding the potential harms of screening and treatment, such as anxiety or the risk of injury to urinary, sexual, or bowel function.

The screening decision is made best in partnership with a trusted source of regular care. Men who have no access to regular care should be tested only if high-quality, informed decision making can be assured through community-based screening programs. Such programs also must assure that participants with abnormal screening results receive appropriate counseling and follow-up care if needed. Availability of follow-up care must not be an afterthought. Unless these program elements are in place, community-based screening should not be initiated.

Once a screening decision has been made, the decision should be readdressed when new research becomes available that significantly alters the balance between benefits, risks, and uncertainties regarding prostate cancer early detection. In the absence of new information, the decision should be readdressed periodically, because a man's health status, values, and preferences can change over time.

For men who choose to be screened for prostate cancer after considering the possible benefits and risks:

  • Screening is recommended with PSA with or without DRE.
  • Screening should be conducted yearly for men whose PSA level is 2.5 ng/mL or greater.
  • For men whose PSA is less than 2.5 ng/mL, screening intervals can be extended to every 2 years.
  • A PSA level of 4.0 ng/mL or greater historically has been used to recommend referral for further evaluation or biopsy, which remains a reasonable approach for men at average risk for prostate cancer.
  • For PSA levels between 2.5 ng/mL and 4.0 ng/mL, health care providers should consider an individualized risk assessment that incorporates other risk factors for prostate cancer, particularly for high-grade cancer, that may be used to recommend a biopsy. Factors that increase the risk of prostate cancer include African American race, family history of prostate cancer, increasing age, and abnormal DRE. A previous negative biopsy lowers the risk. Methods are available that merge this information to achieve an estimate of a man's overall risk of prostate cancer and, more specifically, of his risk of high-grade prostate cancer (see "Beyond Prostate-Specific Antigen: Individualized Risk Assessment," in the original guideline document).

Informed and Shared Decision Making

When the evidence is not clear that the benefits of screening outweigh the risks, an individual's values and preferences must be factored into the screening decision. In light of the uncertain balance between the benefits and risks of prostate cancer screening, it is vital to involve men in the decision whether to screen. This ethical mandate to involve men in the decision-making process stems in part from the preventive nature of screening. By definition, screening involves performing a medical intervention on individuals who are otherwise healthy; i.e., they exhibit no symptoms or signs of the disease. This scenario confers a greater responsibility on the provider to uphold the doctrine of primum non nocere—first, do no harm—than in the case of interventions on symptomatic conditions. Although it is not clear how heavily the balance of benefit and risk must favor a benefit to obviate the need for informed decision making, it is clear that this point has not been reached for prostate cancer screening.

For informed decision making related to prostate cancer screening to occur, the individual should: 1) understand the basic aspects of prostate cancer and the role of screening (core knowledge); 2) understand the uncertainties, risks, and potential benefits associated with testing and the option to not be tested (core knowledge); 3) consider his preferences and values about screening (values); 4) choose a level of participation in the decision with which he is comfortable (role preference); and 5) make (or defer) a decision based on his values and preferences (values-based decision). This definition is adapted from definitions that were developed by the Centers for Disease Control and Prevention Task Force on Community Preventive Services and by the U.S. Preventive Services Task Force. Shared decision making is the subset of informed decision making that is carried out between the patient and his health care provider in the clinical setting. Given the value-dependent nature of prostate screening decisions, health care providers have a particularly important role in the decision for or against testing. First, they can provide men with information on the benefits, limitations, and uncertainties related to screening for prostate cancer. Second, they can help men to explore their values related to prostate cancer screening. Third, they can help men to integrate their knowledge of the benefits and risks of prostate cancer screening with their values to make a decision about screening. Finally, even with adequate information, some men desire a less active role and defer the decision whether to screen to their health care provider. In this situation, although every effort should be made to engage the patient, the provider may use his or her discretion in deciding whether to recommend screening. If possible, the provider should incorporate any knowledge of the patient's health preferences and values into the decision.

Although there are no established criteria for what comprises the key information to impart about prostate cancer screening for informed decision making to occur, core elements were identified from a structured review of the relevant literature and from expert consensus. These core elements of informed decision making are described in the ACS guideline statement for prostate cancer screening in the preceding section and should be included in patient discussions and decision aids.

For most men, the decision to be screened for prostate cancer is not based solely on the facts about screening. A man's values usually play a major role in the decision, and a health professional and decision aids can assist in that decision by helping the patient elucidate his values. One helpful approach can be to provide reasons why some men decide for or against screening, which are outlined in the guidelines statement above.

Offering values-oriented scenarios is one technique to allow men to explore and integrate their values with the information they have received about prostate cancer screening to help them decide whether to be tested. The juxtaposition of the two values scenarios parallels the dichotomous nature of the decision faced by the patient (i.e., screen vs no screen). Although there is no evidence to support the superiority of this approach over others, there is randomized trial evidence that a prostate cancer screening decision aid using values-matching scenarios can help to lower men's decisional conflict.

Tools to Facilitate Informed and Shared Decision Making

The challenge of offering every eligible man the opportunity to make an informed decision about prostate cancer screening can be daunting to the health care provider. The key obstacles to informed decision making and shared decision making (IDM/SDM) cited by providers are time constraints and the complexity of the issue. These barriers likely contribute to the recent findings from the National Survey of Medical Decisions, which demonstrated that prostate cancer discussions with patients did not meet recommended criteria for shared decision making, because discussions were not balanced (predominantly emphasizing benefits) and typically did not engage men to determine personal preferences. Given these barriers, patient decision aids can serve as effective adjunctive tools to facilitate IDM/SDM. The ideal decision aid should provide balanced information regarding prostate cancer screening options, reflect up-to-date information regarding benefits and risks, provide methods for clarifying values, and suggest ways to discuss the decision with health care providers. Decision aids for prostate cancer screening are available in print, web-based, and compact disk (CD) format. Low-literacy versions have been developed but are not yet widely available. Criteria are available for selecting a high-quality decision aid from the International Patient Decision Aids Standards (IPDAS) Collaboration. Several patient decision aids have been evaluated against the IPDAS criteria. Those that are accessible online are listed in Table 1 of the original guideline document. It is important when selecting a decision aid that either it reflects the latest key information related to making a decision about testing (for example, the recent results from the U.S. and European randomized trials) or that the health care provider is able to supplement an otherwise effective tool with the latest data.

Informed Decision Making in Community-Based Screening Programs

There are implicit obstacles to IDM/SDM in community-based screening programs. First, men who attend screening programs may be inherently self selected to desire screening and may not be amenable to efforts at informed decision making. Second, there may not be an opportunity for shared decision making in community-based screening, because there is often no opportunity for interaction with a health care provider who has an adequate understanding of the participants' overall health status. This makes the accurate selection of men who have at least a 10-year life expectancy—the target population for informed decision making for prostate cancer screening—virtually impossible. On the basis of these concerns, the ACS discourages participation in community-based prostate cancer screening programs unless they can provide adequately for an informed decision-making process and appropriate follow-up care. These programs have a special obligation to provide high-quality, objective, informed decision making either through interaction with trained personnel or through the use of validated, high-quality decision aids appropriate to the target population. Moreover, it is incumbent on such programs to assure that participants with abnormal screening results receive appropriate counseling and follow-up care. Because virtually all men age 65 years and older have health insurance through Medicare, they should be discouraged from participating in community-based screening programs and should be referred to a primary care provider.

In summary, because of the uncertainties, risks, and potential benefits of prostate cancer screening, there is an ethical mandate to provide men who are considering screening with the opportunity to engage in an informed decision-making process. Because of the complexity of the decision and the importance of individual values, men should have the opportunity to be assisted by a health professional in reaching this decision. Because there is now an established body of evidence supporting the value and effectiveness of decision aids in facilitating informed decision making, the availability and use of such aids should be promoted.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The Committee considered evidence from randomized controlled trials, case-control studies, and surveillance data and ecologic studies.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Appropriate use of screening procedures for the early detection of prostate cancer
  • Screening with the prostate-specific antigen (PSA) blood test alone or with both PSA and digital rectal examination (DRE) detects cancer at an earlier stage than if no screening is performed.
  • Prostate cancer screening may be associated with a reduction in the risk of dying from prostate cancer; however, evidence is conflicting.
  • Performing a DRE with PSA values between 2.5 ng/mL and 4.0 ng/mL can assist the provider and patient in the decision whether to refer for biopsy.
Potential Harms

Screening Harms

Risks of Phlebotomy and Digital Rectal Examination

  • Harms related to phlebotomy for prostate-specific antigen (PSA) testing are assumed to be the same as for any other small blood volume phlebotomy and generally are negligible.
  • The most frequent complication of digital rectal examination (DRE) in men is discomfort, which can be significant and may explain why it has been demonstrated that DRE poses a barrier to screening. DRE also can lead to rectal bleeding and even syncope, but adverse events are rare.
  • Neither phlebotomy for PSA testing nor DRE poses a significant risk for serious injury.

Risks Associated with PSA

The most frequently reported direct harms associated with prostate cancer screening relate to anxiety. In summary, there is weak evidence, based largely on a surrogate marker (cortisol level) and general anxiety questionnaires, that there is a low level of anxiety associated with the prostate cancer screening process and that there is slightly greater anxiety when individuals are waiting for a biopsy. There is stronger evidence, based on two well designed surveys, that men with false-positive PSA results have higher short-term and long-term prostate-specific cancer worry than men with true-negative results and that men who have false-positive results have more subsequent tests/visits compared with men who have true-negative results. Given the high prevalence of false-positive screens, these deleterious effects are not inconsequential.

Biopsy Risks

  • The two primary biopsy risks are bleeding and infection. Hematuria is observed in about 6% to 13% of patients, but the risk of serious bleeding that requires transfusion is low. To reduce the risk of bleeding, anticoagulants generally are discontinued in advance.
  • The risk of infection occurs as the needle traverses from the rectum into the prostate, although infections associated with biopsy are rarely severe enough to require hospitalization. To reduce the risk of infection, antibiotic prophylaxis usually is used.
  • The rate of urinary tract infection ranges from 0.3% to 4%, and serious infections appear to have a rate of less than 2%.
  • Although it typically is not included in the "risk" category, perhaps one of the greatest potential risks of prostate biopsy is that a prostate cancer may be missed. In addition, in some patients who have been identified with a lower grade cancer, a biopsy may miss concurrent high-grade disease.

Overdiagnosis and Overtreatment

The use of a sensitive screening test for the detection of prostate cancer creates the potential for a significant rate of overdiagnosis and overtreatment, which is the detection and treatment of disease by screening that would never have been diagnosed within the lifetime of the patient. Overdiagnosis and the consequent overtreatment of prostate cancer are significant contributors to the harms and costs associated with PSA screening. Although the possibility of overdiagnosis and overtreatment is real for any disease that is diagnosed through screening, it is a particular concern in prostate cancer screening.

Refer to the original guideline document for specific adverse effects of treatment of prostate cancer, including adverse effects of radical prostatectomy, radiation therapy, hormonal therapy, as well as harms of active surveillance and watchful waiting.

Qualifying Statements

Qualifying Statements
  • Despite the abundance of data that have accumulated regarding the impact of prostate cancer screening on morbidity and mortality, the evidence remains conflicted regarding whether or not there is a benefit from screening.
  • For men whose prostate cancer is detected by screening, it is not currently possible to predict which men are likely to benefit from treatment; some men who are treated may avoid death and disability from prostate cancer, whereas others who are treated would have died from unrelated causes before their cancer became serious enough to affect their health or shorten their lives. 
  • It has become increasingly clear that there is no prostate-specific antigen (PSA) threshold that effectively discriminates between the presence and absence of prostate cancer.
  • It still is not known whether PSA screening performs better in higher risk men in terms of reduced prostate cancer-specific mortality.
  • Although the majority of men undergoing PSA screening in the United States are tested on an annual basis, there is no strong evidence to recommend one interscreening interval over another. Different screening intervals have not been compared in a randomized controlled trial setting.
  • Although the value of adding a periodic digital rectal examination (DRE) to periodic PSA testing is unknown, it will depend in part on the PSA biopsy threshold and the individual who performs the DRE.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Foreign Language Translations
Patient Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Wolf AM, Wender RC, Etzioni RB, Thompson IM, D'Amico AV, Volk RJ, Brooks DD, Dash C, Guessous I, Andrews K, DeSantis C, Smith RA, American Cancer Society Prostate Cancer Advisory Committee. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010 Mar-Apr;60(2):70-98. [154 references] PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
1997 (revised 2010)
Guideline Developer(s)
American Cancer Society - Disease Specific Society
Source(s) of Funding

American Cancer Society

Guideline Committee

American Cancer Society Prostate Cancer Advisory Committee

Composition of Group That Authored the Guideline

American Cancer Society Prostate Cancer Advisory Committee: Andrew M. D. Wolf, MD (Chair), Associate Professor of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Claudia R. Baquet, MD, MPH, Associate Dean for Policy and Planning and Director, Center for Health Disparities, University of Maryland School of Medicine, Baltimore, MD; Gerald Chodak, MD, Chicago, IL; Jennie Cook, American Cancer Society National Assembly Life Member, Larkspur, CA; Anthony V. D'Amico, MD, PhD, Chair, Division of Genitourinary Radiation Oncology, Dana-Farber Cancer Institute and Professor of Radiation Oncology, Harvard Medical School, Boston, MA; Ruth B. Etzioni, PhD, Full Member, Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas D. Fogel, MD, Cabrillo Radiation Oncology Medical Center and Coastal Radiation Oncology Medical Group, Ventura, CA; Paul A. Godley, MD, PhD, MPP, Professor, Hematology/Oncology, University of North Carolina School of Medicine and Member, Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Cynthia M. LeBlanc, EdD, MA (Vice-chair), American Cancer Society National Board of Directors, Richmond, CA; Terry Mason, MD, Chief Medical Officer, Cook County Health and Hospitals System, Chicago, IL; Viraj Master, MD, PhD, Assistant Professor of Urology, Emory University School of Medicine, Atlanta, GA; Andrew L. Salner, MD, Director, Department of Radiation Oncology and Director, Cancer Program, Hartford Hospital, Hartford, CT; Virgil H. Simons, Founder and President, The Prostate Net, Secaucus, NJ; Ian M. Thompson, Jr., MD, Chairman and Professor, Department of Urology, The University of Texas Health Science Center, San Antonio, TX; and Richard C. Wender, MD, Chair and Alumni Professor, Department of Family and Community Medicine, Thomas Jefferson University Medical College, Philadelphia, PA

Financial Disclosures/Conflicts of Interest

Members of the American Cancer Society Prostate Cancer Advisory Committee were asked to disclose relationships, including potential financial conflicts of interest. The following was disclosed: G. Chodak has served on the advisory board for Watson Pharmaceuticals and Ferring Pharmaceuticals; V. Simons has served as a consultant to the State of New Jersey Office of Cancer Control and Prevention for their Cancer Education and Early Detection program, has served as co-investigator to various university-based research studies on reaching African American men to promote disease risk awareness and/or early detection, and is the recipient of educational grants from AstraZeneca, Sanofi-Aventis, GTx, Genentech, and Abbott Oncology for a Patient/Professional Symposium Educational Program (see Form 990 at http://www.guidestar.org External Web Site Policy for more information); I. Thompson has served as a consultant to Mission Pharmacal and to Veridex for a new biomarker that is being tested for future application to the U.S. Food and Drug Administration for detection of prostate cancer. All revenues from this consultancy are transmitted to the University of Texas Health Science Center. He has also received grant support from the Early Detection Research Network, National Cancer Institute. No other potential conflicts relevant to this article were reported.

Guideline Status

This is the current release of the guideline.

This guideline updates previous versions:

Recommendations from the American Cancer Society Workshop on Early Prostate Cancer Detection, May 4-6, 2000 and ACS guideline on testing for early prostate cancer detection: update 2001. CA Cancer J Clin 2001 Jan-Feb;51(1):39-44.

Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 2003 Jan-Feb;53(1):27-43.

Each year the American Cancer Society publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer.

Guideline Availability

Electronic copies: Available from the American Cancer Society Web site External Web Site Policy.

Print copies: Available from the American Cancer Society, 250 Williams St., Suite 600, Atlanta, GA 30303; Web site: www.cancer.org External Web Site Policy.

Availability of Companion Documents

None available

Patient Resources

The following are available:

  • Prostate cancer screening decision aid. Atlanta: American Cancer Society; 2010. 20 p. Electronic copies: Available in Portable Document Format (PDF) from the American Cancer Society (ACS) Web site External Web Site Policy.
  • Prostate cancer detailed guide. Available from the ACS Web site External Web Site Policy.
  • Prostate cancer overview. Available from the ACS Web site External Web Site Policy.
  • Prostate cancer: early detection. Atlanta: American Cancer Society; 2010 Dec 1. 17 p. Electronic copies: Available in Portable Document Format (PDF) from the ACS Web site External Web Site Policy.

A variety of additional patient education resources are available from the American Cancer Society Web site in English External Web Site Policy and Spanish External Web Site Policy.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This summary was completed by ECRI on April 29, 2001. The information was verified by the guideline developer on September 10, 2001. This summary was updated by ECRI Institute on March 18, 2011. The updated information was verified by the guideline developer on April 8, 2011.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

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