The South African Prostate Cancer Screening Guidelines
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i5.2194Keywords:
prostrate, guidelinesAbstract
Prostate cancer (PCa) is the most widespread solid organ malignancy in males and ranks as the fifth leading cause of death globally. Identifying and treating men with clinically significant disease while avoiding the over-diagnosis and over-treatment of indolent disease remains a significant challenge. Several professional associations have developed guidelines on screening and early diagnosis of asymptomatic men with prostate-specific antigen testing. With recent updates from several large randomised prospective trials, the South African Urological Association and the Prostate Cancer Foundation of South Africa have developed these evidence-based recommendations to guide clinicians on PCa screening and early diagnosis for South African men.
References
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209-249. https://doi. org/10.3322/caac.21660
Marima R, Mbeje M, Hull R, Demetriou D, Mtshali N, Dlamini Z. Prostate cancer disparities and management in southern Africa: Insights into practices, norms and values. Cancer Manag Res 2022;14:3567-3579. https://doi.org/10.2147/CMAR.S382903
DewarM,KaestnerL,ZikhaliQ,JehleK,SinhaS,LazarusJ.Investigatingracialdifferencesinclinicaland pathological features of prostate cancer in South African men. S Afr J Surg 2018;56(2):54-58.
Heyns CF, Fisher M, Lecuona A, van der Merwe A. Prostate cancer among different racial groups in the Western Cape: Presenting features and management. S Afr Med J 2011;101(4):267-270. https://doi. org/10.7196/SAMJ.4420
Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part I: Prostate cancer screening. J Urol 2023;210(1):46-53. https://doi.org/10.1097/JU.0000000000003491
Van Poppel H, Hogenhout R, Albers P, van den Bergh RCN, Barentz JO, Roobol MJ. A European model for an organised risk-stratified early detection programme for prostate cancer. Eur Urol Oncol 2021;4(5):731-739. https://doi.org/10.1016/j.euo.2021.06.006
Hugosson J, Roobol MJ, Månsson M, et al. A 16-yr follow-up of the European Randomised Study of Screening for Prostate Cancer. Eur Urol 2019;76(1):43-51. https://doi.org/10.1016/j.eururo.2019.02.009
Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy
for localised prostate cancer. N Engl J Med 2016;375(15):1415-1424. https://doi.org/10.1056/
NEJMoa1606220
WiltTJ,VoTN,LangsetmoL,etal.Radicalprostatectomyorobservationforclinicallylocalisedprostate cancer: Extended follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol 2020;77(6):713-724. https://doi.org/10.1016/j.eururo.2020.02.009
Bill-AxelsonA,HolmbergL,GarmoH,etal.Radicalprostatectomyorwatchfulwaitinginearlyprostate cancer. N Engl J Med 2014;370(10):932-942. https://doi.org/10.1056/NEJMoa1311593
Matsukawa A, Yanagisawa T, Bekku K, et al. Comparing the performance of digital rectal examination and prostate-specific antigen as a screening test for prostate cancer: A systematic review and meta- analysis. Eur Urol Oncol 2024;S2588-9311(23)00292-4. https://doi.org/10.1016/j.euo.2023.12.005
KrilaviciuteA,BeckerN,LakesJ,etal.Digitalrectalexaminationisnotausefulscreeningtestforprostate cancer. Eur Urol Oncol 2023;6(6):566-573. https://doi.org/10.1016/j.euo.2023.09.008
NajiL,RandhawaH,SohaniZ,etal.Digitalrectalexaminationforprostatecancerscreeninginprimary care: A systematic review and meta-analysis. Ann Fam Med 2018;16(2):149-154. https://doi.org/10.1370/ afm.2205
JonesD,FriendC,DreherA,AllgarV,MacleodU.Thediagnostictestaccuracyofrectalexaminationfor prostate cancer diagnosis in symptomatic patients: A systematic review. BMC Fam Pract 2018;19(1):79. https://doi.org/10.1186/s12875-018-0765-y
MottetN,vandenBerghRCN,BriersE,etal.EAU-EANM-ESTRO-ESUR-SIOGguidelinesonprostate cancer – 2020 update. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2021;79(2):243-262. https://doi.org/10.1016/j.eururo.2020.09.042
Sayegh N, Swami U, Jo Y, et al. Race and treatment outcomes in patients with metastatic castration- sensitive prostate cancer. JAMA Netw Open 2023;6(8):e2326546. https://doi.org/10.1001/ jamanetworkopen.2023.26546
DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin 2019;69(3):211-233. https://doi.org/10.3322/caac.21555
PolascikT,OesterlingJE,PartinA.Prostatespecificantigen:Adecadeofdiscovery–whatwehavelearned and where we are going. J Urology 1999;162(2):293-306. https://doi.org/10.1016/S0022-5347(05)68543-6
Oesterling JE, Rice DC, Glenski WJ, et al. Effect of cystoscopy, prostate biopsy, and transurethral resection of prostate on serum prostate-specific antigen concentration. Urology 1993;42(3):276-282.
https://doi.org/10.1016/0090-4295(93)90616-i
Eastham JA, Riedel E, Scardino PT, et al. Variation of serum prostate-specific antigen levels. JAMA 2003;289(20):2695-2700. https://doi.org/10.1001/jama.289.20.2695
NordströmT,AdolfssonJ,GrönbergH,etal.Repeatprostate-specificantigentestsbeforeprostatebiopsy decisions. J Natl Cancer Inst 2016;108(12):djw165. https://doi.org/10.1093/jnci/djw165
Tchetgen M-B, Song JT, Strawderman M, Jacobsen SJ, Oesterling FE. Ejaculation increases the serum prostate-specific antigen concentration. Urology 1996;47(4):511-516. https://doi.org/10.1016/S0090- 4295(99)80486-5
Figueirêdo M de F, Lopes GT, Naidu TG. Digital rectal examination (DRE) does not influence total serum levels of prostate specific antigen (tPSA), in individuals without prostate pathology. Int Braz J Urol 2003;29(5):423-427. https://doi.org/10.1590/S1677-55382003000500006
Crawford ED, Schutz MJ, Clejan S, et al. The effect of digital rectal examination on prostate-specific antigen levels. JAMA 1992;267(16):2227-2228.
Lee R, Localio AR, Armstrong K, Malkowicz SB, Schwartz JS; Free PSA Study Group. A meta-analysis of the performance characteristics of the free prostate-specific antigen test. Urology 2006;67(4):762- 768. https://doi.org/10.1016/j.urology.2005.10.052
Mottet N, Cornford P, van den Bergh R, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer – limited update March 2023. European Association of Urology, 2023. https://uroweb. org/guideline/prostate-cancer/ (accessed 13 March 2024).
Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline amendment 2023. J Urol 2024;211(1):11-19. https://doi. org/10.1097/JU.0000000000003698
Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab 2004;89(5):2179-2184. https://doi.org/10.1210/jc.2003-030330
Guess HA, Gormley GJ, Stoner E, Oesterling JE. The effect of finasteride on prostate specific antigen: Review of available data. J Urol 1996;155(1):3-9.
Rittmaster RS, Norman RW, Thomas LN, Rowden G. Evidence for atrophy and apoptosis in the prostates of men given finasteride. J Clin Endocrinol Metab 1996;81(2):814-819. https://doi. org/10.1210/jcem.81.2.8636309
Eggener SC, Large MC, Gerber GS, et al. Empiric antibiotics for an elevated prostate-specific antigen (PSA) level: a randomised, prospective, controlled multi-institutional trial. Urol Oncol 2013;112(47): 925-929. https://doi.org/10.1111/bju.12241
Government of British Columbia. Prostate Cancer Part 1: Diagnosis and Referral in Primary Care.
cancer-part-1 (accessed 2 May 2024).
GerstenbluthRE,SeftelAD,HampelN,OefereinMG,ResnckMI.Theaccuracyoftheincreasedprostate
specific antigen level (greater than or equal to 20 ng./ml.) in predicting prostate cancer: Is biopsy always
required? J Urol 2002;168(5):1990-1993. https://doi.org/10.1016/S0022-5347(05)64279-6
Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part II: Considerations for a prostate biopsy. J Urol 2023;210(1):54-63. https://doi.org/10.1097/
JU.000000000000349233.
Jang JY, Kim YS. Is prostate biopsy essential to diagnose prostate cancer in the older patient with extremely high prostate-specific antigen? Korean J Urol 2012;53(2):82-86. https://doi.org/10.4111/ kju.2012.53.2.82
Heyns CF, Basson J, van der Merwe A, Zarrabi AD. Clinical (non-histological) diagnosis of advanced prostate cancer: Evaluation of treatment outcome after androgen deprivation therapy. S Afr J Surg 2014;52(3):82-85.
Benedict MOA, Steinberg WJ, Claassen FM, Mofolo N. The profile of black South African men diagnosed with prostate cancer in the Free State, South Africa. S Afr Fam Pract 2023;65(1):e1-e10. https://doi.org/10.4102/safp.v65i1.5553
Heyns CF, Naudé AM, Visser AJ, et al. Early diagnosis of prostate cancer in the Western Cape. S Afr Med J 2001;91(8):679-684.
Rebbeck TR, Devesa SS, Chang B-L, et al. Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of African descent. Prostate Cancer 2013;2013:560857. https://doi. org/10.1155/2013/560857
Marais article (May CME) – details to follow.
Baratedi WM, Tshiamo WB, Mogobe KD, McFarland DM. Barriers to prostate cancer screening by
men in sub-Saharan Africa: An integrated review. J Nurs Scholarsh 2020;52(1):85.94. https://doi.
org/10.1111/jnu.12529
John J, Adam A, Mutambirwa S. Urology care in South Africa: A call for collaboration. S Afr Med J 2024;114(4):e2107. https://doi.org/10.7196/SAMJ.2024.v114i4.2107
John J. Urology pathways for the primary care physician. S Afr Med J 2024;114(4):e1670. https://doi. org/10.7196/SAMJ.2024.v114i4.1670
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