What's new in screening in 2015?

Abstract

Purpose of review The aim of this review was to highlight important articles in the field of prostate cancer (PC) screening published during 2015 and early 2016. Four major areas were identified: 1. screening strategies; 2. post USPSTF 2011–2012; 3. screening trends/patterns; and 4. shared decision making (SDM). Recent findings Several studies furthered the evidence that screening reduces the risk of metastasis and death from PC. Multiplex screening strategies are of proven benefit; genetics and MRI need further evaluation. PSA screening rates declined in men above age 50 as did the overall PC incidence following the USPSTF 2011–2012 recommendation against PSA. The consequences of declining screening rates will become apparent in the next few years. More research is needed to identify the most optimal approach to engage in, and implement, effective SDM in clinical practice. Summary Data emerging in 2015 provided evidence on the question of how best to screen and brought more steps in the right direction of “next-generation PC screening”. Screening is ongoing in all men regardless of whether they might benefit from early detection and treatment or not. After the USPSTF 2011–2012 recommendation the rates of PSA testing are declining, however this decline is observed in all men and not solely in those who will not benefit. The long-term effect of this recommendation might not be as anticipated. More studies are needed on how to implement the best available evidence on who, and when, to screen into clinical practice.

The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA

“…A grade of C would restore patient participation and facilitate individualized shared decision-making (SDM). Today, all professional guideline groups agree that PSA screening ought to take place in the context of SDM between an individual man and his provider 10 . However, there is evidence that SDM, as currently practiced, is sub-par 97–99 .There is evidence that that one in four PCPs order the PSA without discussing it 100 , or do not engage in SDM as “by the book”; only 10%-33% of patient-provider communications cover essential domains of SDM.…”

“…Others include those issued by the American Cancer Society, American Urological Association, European Association of Urology, National Comprehensive Cancer Network and American College of Physicians. Most guidelines emphasize shared decision-making 10 ; however, they diverge in areas such as age to start and stop screening, screening intensity and the PSA level at which to refer a patient for prostate biopsy 10–13 . Many of the guidelines agree that screening does not benefit men with a life expectancy of less than 10 years 12, 13 .…”

Prostate cancer screening—when to start and how to screen?

“…Multivariable approaches to reduce the number of biopsies have long been proposed through the use of risk calculators, e.g., the ERSPC or PCPT risk calculators, which combine clinical information with PSA into predicted risk of high-grade PCa on biopsy ( 17 ). MRI has been proposed to be used in combination with PSA and/or other biomarkers or risk calculators to further stratify risk and is currently being studied.…”

Towards personalized prostate cancer screening

“…Eapen et al [43] support an individualized decisionmaking, as opposed to the dichotomy between a general population screening protocol and a not-screening anyone protocol. In the same vein, Carlsson and Roobol [44] advocate a new-generation screening protocol based on new biomarkers and risk stratification based on baseline PSA. Recommendations of personalized screening introduce a new paradigm for reflection that could change the risk/benefit balance of PCa screening based on the risk of each patient.…”