Published online before print March 3, 2010
CA Cancer J Clin 2010
doi: 10.3322/caac.20067
© 2010 American Cancer Society
Introducing the 2010 American Cancer Society Prostate Cancer Screening Guideline
Otis W. Brawley, MD1 and
Ted Gansler, MD, MBA2
1Chief Medical Officer, Editor-in-Chief, A Cancer Journal for Clinicians, American Cancer Society, Atlanta, GA
2Director of Medical Content, Editor, A Cancer Journal for Clinicians, American Cancer Society, Atlanta, GA
Corresponding author: Ted Gansler, MD, MBA, American Cancer Society, Health Promotions, 13 Sloop Drive, Cocoa Beach, FL 32931; ted.gansler{at}cancer.org
DISCLOSURES: The authors reported no conflicts of interest.
In this issue of CA is an article describing the 2010 update of the American Cancer Society (ACS) prostate cancer early detection guidelines.1 These guidelines were put together by a group of volunteer experts in a process lasting nearly a year. The process was initiated because updates of several clinical trials pertinent to the question of prostate cancer screening were published in early 2009.2,3
These guidelines acknowledge that these studies clarify some issues and further legitimize some questions or uncertainties regarding the screening and treatment of this disease. The ACS 2010 guidelines for the early detection of prostate cancer are very similar to the corresponding guidelines of 1997 and 2001.4–6 In many respects, this is a credit to the process undertaken in 1997 and 2001 and the ACS volunteers who worked on those guidelines. The current ACS guidelines are also very similar to the advice given by Michael Barry in his 2009 editorial accompanying the publication of the 2 prospective randomized clinical trials concerning prostate cancer screening.7
This guideline document is long and complex. To paraphrase a wise epidemiologist who studied it, "Sometimes it is not possible to simplify something that is complex." Prostate cancer screening is complex. The ACS guidelines are neither a statement against prostate screening nor a statement for prostate screening; rather, they are a statement for informed or shared decision making. More clearly than in 1997 and 2001, these guidelines state that there are definite uncertainties regarding the efficacy of prostate cancer screening, there are known risks associated with it, and there may be a benefit.
In these guidelines, the ACS has taken a clear position discouraging routine or mass screening and encouraging a discussion within the physician-patient relationship. The clarification of this point is especially noteworthy, because since 1997 the ACS position has been described inaccurately or even misleadingly in the popular media (frequently), in the medical media (less often), and in commercial advertisements in a manner suggesting that the ACS endorses routine or mass screening. Some of these advertisements have promised, and even more have implied, unproven benefits of screening with no mention of the ACS emphasis on informed decision making. We believe that men deserve truthful and understandable information regarding what is known and what is uncertain concerning the harms and benefits associated with the early detection of prostate cancer. They certainly do not deserve propaganda that selectively presents or ignores the relevant evidence, or that misrepresents ACS guidelines.
Given the recent debate over breast cancer screening among women in their 40s, some will wonder why the ACS recommends mammography screening with the provision of information regarding the risks and benefits for healthy women aged 40 years and older but recommends informed decision making for men with prostate cancer. In addition, some may be unaware of the important distinction between informed decision making and providing information.8 The answer is that even the US Preventive Services Task Force agrees that there are 9 prospective randomized clinical trials that demonstrate a breast cancer mortality benefit for mammography screening.9 There is only 1 prospective randomized clinical trial that in an early analysis has suggested a small mortality advantage to prostate cancer screening, and even this study reported a large excess number of men receiving treatments that we know to be frequently harmful and unnecessary.3 A second similar trial has not confirmed an association between testing for early detection and a prostate cancer mortality advantage, but did confirm significant numbers of men receiving treatment.2
Although the guidelines are the result of a 1-year review of the literature, the real effort now begins as we work with men, their physicians and other health care professionals, and other stakeholders to implement them.
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Footnotes
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Available online at http://cajournal.org and http://cacancerjournal.org 
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References
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- Wolf AMD, Wender RC, Etzoni RB, et al. American Cancer Society guidelines for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010;60: (In Press).
- Andriole GL, Crawford ED, Grubb RL III, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310–1319.[Abstract/Free Full Text]
- Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320–1328.[Abstract/Free Full Text]
- von Eschenbach A, Ho R, Murphy GP, Cunningham M, Lins N. American Cancer Society guideline for the early detection of prostate cancer: update 1997. CA Cancer J Clin. 1997;47:261–264.[Abstract]
- Eyre HJ. The American Cancer Society's prostate cancer position. CA Cancer J Clin. 1997;47:259–260.[CrossRef][Medline]
- Smith RA, von Eschenbach AC, Wender R, et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001-testing for early lung cancer detection. CA Cancer J Clin. 2001;51:38–75.[Abstract/Free Full Text]
- Barry MJ. Screening for prostate cancer—the controversy that refuses to die. N Engl J Med. 2009;360:1351–1354.[Free Full Text]
- Rimer BK, Briss PA, Zeller PK, Chan EC, Woolf SH. Informed decision making: what is its role in cancer screening? Cancer. 2004;101 ( 5 suppl):1214–1228.[CrossRef][Medline]
- U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716–236.[Abstract/Free Full Text]
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References