title: Reconciling primary care and specialist perspectives on prostate cancer screening.
abstract: When specialists propose screening guidelines for primary care clinicians to implement, differences in perspectives between the 2 groups can create conflicts. Two recent specialty organization guidelines illustrate this issue. The American Urological Association guideline panel and National Comprehensive Cancer Network recommend that average-risk men first be counseled about the risks and benefits of prostate-specific antigen screening for prostate cancer at age 40 rather than at the previously recommended age of 50 years. There is no direct evidence, however, that this recommendation has any impact on prostate cancer-specific mortality. To avoid distracting primary care clinicians from providing services with proven benefit and value for patients, professional organizations should follow appropriate standards for developing guidelines. Primary care societies and health care systems should also be encouraged to evaluate the evidence and decide whether implementing the recommendations are feasible and appropriate.
authors.affiliation: Medicine Service, Albuquerque VA Medical Center, Departments of Medicine and Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. rhoffman@unm.edu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barry
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roberts
authors.forename: Harold C
authors.initials: HC
authors.lastname: Sox
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011320:Primary Health Care; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D013038:Specialization
chemical_list: D017430:Prostate-Specific Antigen