CTF Summary Table: Screening for Prostate Cancer

Canadian Task Force on Preventive Health Care

Summary Table of Recommendations

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Screening for Prostate Cancer

Prepared by John W. Feightner, Professor of Family Medicine, University of Western Ontario, London

These recommendations were finalized by the Task Force in June 1994

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Digital Rectal Examination (DRE)* Routine screening results in increased detection of early cancers but the maneuver can only detect small cancers in the posterior and lateral aspects of the prostate. Cohort analytic (descriptive) studies (II-3); Case control study <5-10> (II-2) Poor evidence to include or exclude DRE from the periodic health examination (PHE) for men over 50 years of age (C); while DRE has limitations in its ability to detect early prostate cancer, there is insufficient evidence to recommend that physicians who currently include DRE in their examinations should change that behaviour.

The effectiveness of therapy is unproven but carries significant risks of important adverse effects. Overview and decision analysis of cohort analytic (descriptive) studies <27-29> (II-3)

Prostate specific antigen (PSA) While PSA can identify prostate cancer at an earlier stage, the false- positive rates range from 67% to 93%. Cohort analytic (descriptive) studies <19-25> (II-3) Exclusion is recommended on the basis of low positive predictive value and the known risk of adverse affects associated with therapies of unproven effectiveness. Fair evidence to exclude routine screening with PSA from the periodic health examination of asymptomatic men over 50 years of age. (D)

The effectiveness of therapy is unproven but carries significant risks of important adverse effects. Overview and decision analysis of cohort analytic (descriptive) studies <27-29> (II-3)

Transrectal Ultrasound (TRUS) Imaging techniques do not specifically detect malignant disease in the prostate; their routine use for screening would pose problems of feasibility and cost. Cohort analytic (descriptive) studies <12-18> (II-3) Fair evidence to exclude from the periodic health examination of asymptomatic men over 50 years of age. (D)

* DRE can also be done for other reasons (other than to detect prostate cancer).

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
Digital Rectal Examination (DRE)*	Routine screening results in increased detection of early cancers but the maneuver can only detect small cancers in the posterior and lateral aspects of the prostate.	Cohort analytic (descriptive) studies (II-3); Case control study <5-10> (II-2)	Poor evidence to include or exclude DRE from the periodic health examination (PHE) for men over 50 years of age (C); while DRE has limitations in its ability to detect early prostate cancer, there is insufficient evidence to recommend that physicians who currently include DRE in their examinations should change that behaviour.
Digital Rectal Examination (DRE)*	The effectiveness of therapy is unproven but carries significant risks of important adverse effects.	Overview and decision analysis of cohort analytic (descriptive) studies <27-29> (II-3)
Prostate specific antigen (PSA)	While PSA can identify prostate cancer at an earlier stage, the false- positive rates range from 67% to 93%.	Cohort analytic (descriptive) studies <19-25> (II-3)	Exclusion is recommended on the basis of low positive predictive value and the known risk of adverse affects associated with therapies of unproven effectiveness. Fair evidence to exclude routine screening with PSA from the periodic health examination of asymptomatic men over 50 years of age. (D)
Prostate specific antigen (PSA)	The effectiveness of therapy is unproven but carries significant risks of important adverse effects.	Overview and decision analysis of cohort analytic (descriptive) studies <27-29> (II-3)
Transrectal Ultrasound (TRUS)	Imaging techniques do not specifically detect malignant disease in the prostate; their routine use for screening would pose problems of feasibility and cost.	Cohort analytic (descriptive) studies <12-18> (II-3)	Fair evidence to exclude from the periodic health examination of asymptomatic men over 50 years of age. (D)