Guidelines place greater emphasis on patients making informed decisions.
On March 4, 2010, the American Cancer Society (ACS) released its updated prostate cancer screening guidelines. The biggest change was the role that patients play in the decision-making process. The ACS now recommends that principles of shared decision-making guide decisions about prostate cancer screening. ACS recommends that asymptomatic, average-risk men with at least a 10 year life expectancy should begin receiving information at age 50 that allows them to make informed decisions about prostate cancer screening. ACS continues to recommend that men with life expectancies of less than 10 years should not undergo prostate cancer screening. Men at higher risk for prostate cancer, such as men with a first-degree relative diagnosed with prostate cancer and African American men, should begin receiving information about prostate cancer screening at age 45. Men who have multiple family members diagnosed with prostate cancer should begin receiving information about prostate cancer screening at age 40. Information about prostate cancer screening should include the uncertainties, risks, and potential benefits of screening. The updated ACS Guidelines are based on recent studies that found that the risk-benefit ratio for prostate cancer screening remains unclear.
The decision to undergo, or not undergo, a prostate biopsy needs to be an informed decision. Historically, men have been advised to have a biopsy when their prostatic specific antigen (PSA) level was elevated and/or an enlarged prostate gland was detected by digital rectal examination (DRE). Men now need to be informed about their personal risk and the risks and benefits of screening. Other factors, such as comorbid disease and free and total PSA, and PSA density and velocity, need to be considered.
There is a need to develop prostate screening tests that differentiate the slow growing and relatively harmless prostate cancers from those that are aggressive and potentially lethal. Until then, men need to be advised of the risks and benefits of available prostate screening tests and make informed decisions whether or not to undergo screening. The response from the physician community regarding the new emphasis on informed decision-making has been mixed. One comment was that explaining the new screening recommendations will take a great deal of time and physicians are not paid when they have lengthy conversations with patients. This may be yet another opportunity for nurses, especially advanced practice nurses, to fill this gap by offering information and counseling about prostate cancer screening.