ACP approves guidelines on prostate cancer screening, Lyme disease
ACP's Clinical Efficacy Assessment Project (CEAP) has weighed in on the controversy about whether early detection of prostate cancer generally does more harm than good.
It concluded, after four years of research and debate, that ACP should not recommend routine screening for prostate cancer with DRE or PSA in average risk men at any age. The College does "strongly recommend," however, that physicians help enroll eligible men in ongoing studies to help determine whether there may be a place for routine screening. Prostate cancer is the most commonly diagnosed malignancy among men in the United States.
ACP's Board of Regents approved the new clinical practice guideline on prostate cancer screening last month. The full guideline and its supporting background papers will be submitted to Annals of Internal Medicine for possible publication.
While CEAP investigators concluded that neither DRE nor PSA is expensive or dangerous, they also found that there is no "direct evidence from controlled trials that screening and subsequent treatment provides a net benefit for the average man." The strongest available evidence against screening is for men older than 70 with average risks.
The evidence is least clear for men between the ages of 50 and 69, investigators said. They advise physicians and patients to discuss the issues of costs, harms and benefits carefully before deciding whether to screen or forgo testing.
According to the new guideline, "Routine performance of PSA testing without first conducting a frank discussion of these issues is inappropriate."
Last month the Regents also approved a CEAP guideline for the laboratory confirmation of Lyme disease. Given the limitations of the laboratory tests used for this disease, the College recommends that physicians not refer a patient for Lyme disease testing (using ELISA or immunofluorescent assay [IFA]) until they do a thorough clinical examination of the patient and find "objective clinical signs" of the disease and assess the incidence of Lyme disease in the community.
"Patients presenting with symptoms such as arthralgia, myalgia, headache, fatigue or palpitations alone, without the presence of the objective signs of Lyme disease, have an extremely low probability of true Lyme disease and should not be referred for laboratory testing," the guideline concludes.
If a patient is sent for testing, CEAP investigators recommend that labs follow a two-test protocol, using either ELISA or IFA followed by a confirmatory Western immunoblotting of all specimens with indeterminate results.
In other action last month, the Board of Regents agreed to extend the term of membership for Associates to six years post-graduation from medical school or for as long as the physician is doing approved postgraduate training in internal medicine or one of its subspecialties.
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