AUA Releases New PSA Guidelines
I n April of 2009, the American Urological Association (AUA) issued new clinical guidelines regarding early detection of prostate cancer and the PSA test.
A summary follows:
The AUA recommendation is: The PSA (prostate-specific antigen) test should be offered to well-informed men aged 40 or older who have a life expectancy of at least 10 years.
The future risk of prostate cancer is closely related to a man’s PSA score; a baseline PSA level above the median for age 40 is a strong predictor of prostate cancer.
Such testing may not only allow for earlier detection of more curable cancers, but may also allow for more efficient, less frequent testing.
Men who wish to be screened for prostate cancer should have both a PSA test and a digital rectal exam (DRE).
The Guidelines also note that other factors such as family history, age, overall health and ethnicity should be combined with the results of PSA testing and physical examination in order to better determine the risk of prostate cancer.
The Guidelines recommend that the benefits and risks of screening of prostate cancer should be discussed including the risk of over-detection, detecting some cancers which may not need immediate treatment.
In regard to biopsy, a continuum of risk exists at all values, and major studies have demonstrated that there is no safe PSA value below which a man may be reassured that he does not have biopsy-detectable prostate cancer.
Therefore, the AUA does not recommend a single PSA threshold at which a biopsy should be obtained. Rather, the decision to biopsy should take into account additional factors, including: free and total PSA, PSA velocity and density, patient age, family history, race/ethnicity, previous biopsy history and other patient existing diseases.
The AUA Best Practice Statement also clarifies a number of key points about the use of PSA in treatment selection and in post-treatment follow up of prostate cancer patients. In this article, Quest has not summarized those positions.
To review the complete AUA Best Practices Guidelines for Management of Clinically Localized prostate Cancer, go to: www.auanet.org/guidelines