Some cancer centers don’t follow evidence-based guidelines for prostate screening

By Judith Garber | March 18, 2022

For those considering prostate cancer screening, it’s important to take both the benefits and harms into account. Despite some evidence showing a relationship between screening and early detection of metastatic prostate cancer, screening has not been shown to reduce all-cause mortality. On the other hand, many prostate cancers never become harmful and patients can be subjected to unnecessary treatment that affects their quality of life.

Because patients have different values when it comes to cancer screening, the US Preventive Services Task Force, American Cancer Society, and American Urological Association recommend not routinely screening men for prostate cancer, but instead having a discussion about the benefits and harms of screening first.

However, in America’s cancer centers, where many patients go for specialized cancer treatment, policies do not always align with these recommendations. In a recent study in JAMA Internal Medicine, researchers at the Weill Cornell Medical Center examined public recommendations on prostate screening from the websites of 607 cancer centers.

The researchers found many discrepancies between the recommendations at the cancer centers and national guidelines. One-quarter of cancer centers recommend that men be screened without a shared decision making conversation first. Additionally, most cancer centers (78%) do not include an age cutoff for recommending screening, despite national guidelines advising screening be discontinued at age 70 or in men with fewer than 10 years of life expectancy. And more than 60% of centers do not discuss the risks of screening on their websites.

Interestingly, cancer centers designated by the National Cancer Institute (NCI) were more likely to diverge from the guidelines in their prostate screening recommendations. Among these 44 cancer centers, nearly half recommended universal screening rather than shared decision making. Most NCI-designated centers are affiliated with universities and focus on cancer-specific research.

“The divergence between these recommendations and national society guidelines highlights the need to encourage shared decision-making for men considering screening,” the authors write. In particular, NCI-designated cancer centers should work to align their recommendations with the evidence.

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