Comparison of three guidelines for screening, diagnosis and staging of prostate cancer in the USA and Europe

Abstract

Background: Prostate cancer is the most frequent malignancy for males. The recommendations of guidelines for screening and diagnosis play an important role in the clinical practice of many urologists. However, there are several discrepancies between these guidelines that have not been evaluated. Methods: The European Association of Urology (Europe), the National Comprehensive Cancer Network (USA), and the American Urological Association (USA) guidelines were examined analyzing the agreements and discrepancies between each guideline. Results: There are many agreements and discrepancies between each guideline, namely: 1) Age for the initiation of PSA screening, including patients at high risk: discrepancies 2) Age to stop screening: discrepancies 3) Evaluation of germline risk variants in patients at high risk, especially BCRA2 mutation: discrepancies 4) Additional tests to avoid unnecessary biopsies: agreement. 5) Indication to perform a first prostate biopsy: discrepancies. 6) Systematic biopsy cannot be ignored in the first biopsy: agreement. 7) From a negative biopsy it is necessary to perform an mpMRI to increase the detection of lesions: agreement 8) Risk stratification: discrepancies. 9) Clinical stratification: discrepancies. Conclusion: A unanimity of criteria is necessary in the three guidelines. Nevertheless, each guide must also take into account certain social and economic situations. Our proposal is the establishment of common minimum criteria that must be met in the diagnostic process for all affected men in our societies.