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Article of the week: Guideline of guidelines: prostate cancer screening

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The introduction is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

If you only have time to read one article this week, it should be this one.

Guideline of guidelines: prostate cancer screening

Stacy Loeb
Department of Urology and Population Health, New York University, New York, NY, USA


Prostate cancer screening is one of the most controversial topics in urology [1]. On one hand, there is randomised data showing that PSA screening results in earlier stages at diagnosis, improved oncological outcomes after treatment, and lower prostate cancer mortality rates. However, the downsides include unnecessary biopsies due to false-positive PSA tests, over-diagnosis of some insignificant cancers, and potential side-effects from prostate biopsy and/or prostate cancer treatment. The ongoing controversy is highlighted by the divergent recommendations on screening from multiple professional organisations. The purpose of this article is to summarise the recent guidelines on prostate cancer screening from 2012 to present.

8 replies
  1. Prokar Dasgupta
    Prokar Dasgupta says:

    Doctors seek clear guidance and not confusion.
    Guideline of Guidelines may be the solution and evidence based summary that every urologist needs for their clinical practice.
    Enjoy the first in the series and cite it widely!

  2. Declan Murphy
    Declan Murphy says:

    Very nice overview Stacy and congratulations to Prokar and BJUI for starting this nice series “Guidelines of Guidelines”. We sometimes do need help distilling the various guidelines out there.

  3. David Bouchier-Hayes
    David Bouchier-Hayes says:

    Excellent synopsis/overview, Stacey. I’ve often felt that the views of the USPTF are akin to saying that early man should have given up using fire, because many people got burnt. However, with time we’ve leant to control fire and have probably benefitted more from it than any other discovery in history (smartphones excepted!). We must continue to do the same with PSA, learn how to manage and control it better. This synopsis is a worthy step on that journey.

  4. John Davis
    John Davis says:

    Great job Stacy – a fast and effective read, and a dream come true for Prokar to get this series started finally. Look forward to more.

  5. Gwyn Jackson
    Gwyn Jackson says:

    The PSA test is part of the tool kit in the diagnosis of prostate cancer. These guidelines are helpful but many men I speak to tend to put too much trust in their PSA score.

  6. Yvonne Bessem
    Yvonne Bessem says:

    I am very happy to have come across such an article. I also think in countries with the socialist system, screening is free for men from ages of 35 once every year. It also helps, but the problem is, some people are not very well informed and others have phobia going to see the physician. We can only spread the word, early diagnosis increases probability of cure.

  7. Phil O'Loingsigh
    Phil O'Loingsigh says:

    You can understand, after reading this article, how the public are confused about PSA testing, especially if they google it. The Irish Cancer Society have a very good booklet on the PSA Test which gives the reader very calm, balanced and easy to comprehend information on the test and other possible interventions.

  8. joanne hough
    joanne hough says:

    A good overview. Lots of facts and figures, but a little bit more of a discussion would have been nice. Hopefully one day there will be a more reliable testing procedure.

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