Urologists' Group Issues Updated Guidelines on PSA Test05/03/13
FRIDAY, May 3 (HealthDay News) -- New guidelines from the
nation's leading group of urologists on the controversial PSA test
for prostate cancer highlight the importance of discussions between
a man and his doctor.
Especially for men in their late 50s and 60s, the usefulness of
the blood test may have to be decided on a case-by-case basis,
according to new recommendations from the American Urological
One expert called the new guidelines "a paradigm shift" in
prostate cancer detection.
Dr. Louis Potter, chairman of radiation medicine at North
Shore-LIJ Health System in New Hyde Park, N.Y., said the
recommendations mark a move to more "personalized health
management, where risk and age are balanced against the value of
Prostate-specific antigen (PSA) screening is a test that
measures the level of a key marker for prostate cancer in the
blood. In general, the higher the level of this protein, the more
likely it is that a man has prostate cancer, according to the U.S.
National Cancer Institute.
The value of the PSA test has recently come into question,
however, with several studies suggesting it causes men more harm
than good -- spotting too many slow-growing tumors that, especially
in older patients, may never lead to serious illness or death. In
2012, the U.S. Preventive Services Task Force, an influential
government-appointed panel, advised against the routine use of the
PSA test for prostate cancer.
The new AUA guidelines are more nuanced. The group does
recommend against the PSA test for men under age 40 or for those
aged 40 to 54 at average risk for prostate cancer.
The AUA says, however, that men aged 55 to 69 should talk to
their doctors about the risks and benefits of PSA screening and
make a decision based on their personal values and preferences.
Routine PSA screening is not recommended for men over age 70 or
any man with less than a 10- to 15-year life expectancy.
The best evidence of benefit from PSA screening was among men
aged 55 to 69 screened every two to four years. In this group, PSA
testing was found to prevent one death a decade for every 1,000 men
screened. But this benefit could be much greater over a lifetime,
the guidelines noted.
The guidelines also said PSA screening could benefit men in
other age groups who are at higher risk of prostate cancer due to
factors such as race and family history. These men should discuss
their risk with a doctor and assess the benefits and potential
harms of PSA testing.
The new guideline updates the AUA's 2009 Best Practice Statement
on Prostate-Specific Antigen and was announced at the association's
annual meeting in San Diego on Friday.
"There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer," Dr. H. Ballentine Carter, who chaired the panel that developed the guidelines, said in an AUA news release.
There is more and better data about PSA screening available
today than there was in 2009, so it is "time to reflect on how we
screen men for prostate cancer and take a more selective approach
in order to maximize benefit and minimize harms," Carter said.
One expert said the revised guidelines made sense.
"I think these guidelines are quite appropriate given the [slow-growing] nature of many prostate cancers," said Dr. Erik Goluboff, an attending urologist in the department of urologic oncology at Beth Israel Medical Center in New York City.
He agreed that discussions between a patient and his doctor on
the PSA test are "extremely important."
"It has become increasingly evident that many, if not most, men diagnosed with early prostate cancer will never need treatment and can be spared the potentially devastating side effects of treatment such as urinary incontinence and erectile dysfunction," Goluboff said.
Some men, including black patients and patients with a family
history of prostate cancer, may still decide to undergo PSA
testing, he added. "This is in contrast to the U.S. Preventive
Services Task Force, where a blanket statement that PSA screening
is bad, regardless of individual patient risk, was made," Goluboff
A better test that pinpoints aggressive, life-threatening
prostate tumors might be developed in the future, to better guide
patients. "Hopefully, with discovery of better tumor markers,
aggressive prostate cancers can be distinguished from
[slow-growing] ones and only patients who need to will receive
treatment," Goluboff said.
The U.S. National Cancer Institute has more about
prostate cancer screening.
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