Secondary Prevention of Prostate Cancer (1991)
RECOMMENDATIONS
- There is fair evidence that DRE, with its poor test characteristics, performs as well as or better than other available tests (TRUS and determination of the PAS and prostatic acid phosphatase levels). DRE is feasible, relatively cost-effective, and acceptable and can be adopted to case-finding in the primary care setting. Only about half of the nodules detected through DRE will be malignant, and this must be weighed against the risks and costs of diagnostic and staging procedures. There is fair evidence for the positive effect of early detection on the stage distribution (clinical staging) of prostate cancer at diagnosis. Outcomes of treatment become less favourable as the stage of disease increases. Treated patients with stage A2 or B disease appear to have better survival than untreated patients. Since there is no alternative technology that performs better than DRE in detecting early-stage prostate cancer and since the burden of illness is potentially heavy DRE should not be excluded from the periodic health examination of asymptomatic men over 40 years of age. However, the evidence for including or excluding DRE is of poor quality. Since the effectiveness of DRE in terms of detection depends on skill, medical training, and teaching techniques should be adapted to ensure that graduating physicians possess this skill. (grade C recommendation)
- There is fair evidence, based on poor test performance, to exclude the use of prostatic acid phosphatase and PSA screening from the periodic health examination of asymptomatic men over 40 years of age. (grade D recommendation)
- There is fair evidence, also based on poor test performance, to exclude TRUS and other imaging techniques from the periodic health examination of asymptomatic men over 40 years of age. (grade D recommendation)
- Decisions to use these clinical procedures among symptomatic men or those in whom there is prior suspicion of prostate cancer should be made on the basis of clinical judgement – TRUS may be of particular benefit. These tests and procedures have important clinical functions in the diagnosis of prostate and the monitoring of patient management.