Prostate Cancer Early Detection, Version 2.2015

The 2015 NCCN Guidelines for Prostate Cancer Early Detection emphasized the importance of early detection through PSA testing to reduce mortality, while acknowledging the risks of overdetection and overtreatment. The guidelines recommended PSA testing for informed, healthy men, supported by evidence from trials like the ERSPC and Göteborg, which showed significant mortality reductions. However, the limitations of PSA as a non-cancer-specific marker were noted, with only 25% of men with elevated PSA levels having prostate cancer. The guidelines discussed factors affecting PSA levels, controversies around testing, and the importance of selective treatment. They recommended baseline PSA testing for men aged 45 to 55, with frequency adjustments based on PSA levels. High-risk groups, such as African-American men and those with BRCA mutations, were identified, though specific strategies were not established. Novel imaging techniques like multiparametric MRI and biomarker tests were discussed for refining biopsy decisions. The guidelines stressed individualized decision-making and the need for ongoing evaluation as new evidence emerged.