Introduction
Prostate cancer (PCa) is the most widespread non-cutaneous cancer found in males and ranks as the fifth leading cause of death globally. [1] In South Africa (SA), PCa is the predominant solid organ cancer detected, regardless of ethnic background, [1] and its prevalence in southern Africa has increased by ~60% during the past 15 years. [2] Black SA men typically receive a diagnosis at a more adva
Prostate cancer (PCa) is the most widespread non-cutaneous cancer found in males and ranks as the fifth leading cause of death globally.[1] In South Africa (SA), PCa is the predominant solid organ cancer detected, regardless of ethnic background,[1] and its prevalence in southern Africa has increased by ~60% during the past 15 years.[2] Black SA men typically receive a diagnosis at a more advanced stage and exhibit a higher histological grade compared with SA men of other ethnic backgrounds.[3,4]
Organised screening of asymptomatic men uses prostate-specific antigen (PSA) testing to detect cancer in its early stages and reduce PCa-related morbidity and mortality. However, there is evidence indicating that a significant number of men undergo PSA testing without being adequately informed about the potential hazards and benefits associated with testing. Additionally, numerous men undergo PSA testing in a manner that deviates from the criteria outlined in guidelines. These deviations include testing too frequently, at a young age, at an advanced age, or when short life expectancy precludes any survival benefits from screening.
Identifying and treating men with clinically significant PCa while avoiding overdiagnosis and overtreatment of indolent disease remains a significant challenge. It is therefore necessary to establish evidence-based guidelines and recommendations for screening for PCa for SA. These guidelines will help ensure that PSA testing is used appropriately, thereby allowing men and their doctors to have open discussions regarding screening, and enable clinicians and their patients to make informed decisions based on the latest available evidence. Men who choose to undergo screening should be provided with information regarding the appropriate age to begin testing, the recommended frequency of screening, the appropriate time to discontinue testing, and the threshold PSA level that should trigger further examination.
It is important to make the distinction between screening and diagnostic testing. Screening refers to testing an asymptomatic patient with an increased risk of developing PCa. Symptomatic patients need further diagnostic work-up, which is beyond the scope of these guidelines. The recommendations below therefore apply specifically to asymptomatic patients who are considered for PCa screening.
South African Urology Association and the Prostate Cancer Foundation of South Africa: The South African Prostate Cancer Screening Guidelines (SAMJ_CME)_May 2024, Vol. 114, No. 5