The new guideline is supported by narrative intended to help patients understand the complexities of obtaining screening for prostate cancer. The narrative notes:

Men who choose to undergo screening should begin at age 50 years. However, men in high risk groups, such as those with a strong familial predisposition (e.g. two or more affected first degree relatives) or African Americans may begin at a younger age (e.g. 45 years). More data on the precise age to start prostate cancer screening are needed for men at high risk.

Screening for prostate cancer in asymptomatic men can detect tumors at a more favorable stage (anatomic extent of disease). There has been a reduction in mortality from prostate cancer, but it has not been established that this is a direct result of screening.

An abnormal PSA test result has been defined as a value of above 4.0 ng/ml. Some elevations in PSA may be due to benign conditions of the prostate.

The DRE of the prostate should be performed by health care workers skilled in recognizing subtle prostate abnormalities, including those of symmetry and consistency, as well as the more classic findings of marked induration or nodules. DRE is less effective in detecting prostate cancer compared with PSA.

There are two important differences between the old and new guidelines. First, the new guideline reflects research which notes that some groups of men may be at higher risk of developing prostate cancer, including those that have a strong familial predisposition to the disease and African American men. African Americans have a 34% higher incidence rate of prostate cancer than white Americans. The second point of difference between the new and the old guidelines is the cautionary note that men should have at least a 10-year life expectancy in order to receive these test. This is based on a recognition that prostate cancer is often a slow-growing cancer and a man with less than a 10-year life expectancy is likely to die of another cause without benefit from detection and treatment for his cancer.

"Since 1992, new data have become available that have impacted the Society's guideline on the early detection of prostate cancer," says Andrew C. von Eschenbach, MD, chair of the Society's Advisory Group on Prostate Cancer and a professor of urology and director of the Prostate Cancer Research Program at the University of Texas MD Anderson Cancer Center. As with the Society's other guidelines for the early detection of cancer, the prostate cancer guideline is based on a review of the most current scientific evidence available.

Even though there are no prospective, randomized studies which compare the death rates from prostate cancer in men who have been screened verus those who have prostate cancer discovered "accidentally" or because of symptoms, many physicians believe that screening confers a benefit. "It is a general principle of cancer control that early diagnosis is preferable to late diagnosis," says Myles Cunningham, MD, president of the American Cancer Society. "There is no effective treatment for advanced stage prostate cancer, but there is curative treatment for early stage prostate cancer." The five-year survival rates for early stage prostate cancer can be as high as 99%.

Prostate cancer will be diagnosed in approximately 209,900 men in the US in 1997. More than 41,000 men will die of the disease, making prostate cancer the second leading cause of cancer death in men, exceeded only by lung cancer.

The Society's guidelines are recommendations, not rules, and are meant to be flexible to accommodate individual medical and personal needs.

For further information on prostate cancer, or the new guidelines, call the American Cancer Society at 1-800-ACS-2345.



Joann Schellenbach
National Director Media Relations
American Cancer Society
212-382-2169
jschelle@cancer.org