New guidelines on prostate cancer screening, issued today by the American Urological Association (AUA), are supportive of routine use of the prostate-specific antigen (PSA) test in healthy men, but only for a specified age group, and only after discussion between a man and his physician.
Specifically, the new guidelines state that men 55 to 69 years of age who are at average risk and asymptomatic can consider PSA screening. They should speak to the their physician about the benefits and harms of testing to determine the best course of action.
This is a major difference from the guidelines issued last year by the US Preventative Services Task Force (USPSTF), which recommended against any routine use of the PSA test, concluding that any benefit is outweighed by harm.
“We recognize that there are some men who could benefit from screening,” said Ballentine Carter, MD, professor of urology and oncology at the Johns Hopkins Medicine and director of adult urology at the Brady Urological Institute in Baltimore, Maryland, who chaired the guideline committee.
“In the age group that we identified — 55 to 69 — there is evidence that there may be more benefit than harm,” Dr. Carter told Medscape Medical News. But only in that age range, he emphasized; for other age groups, the panel could not recommend routine screening.
Another difference is that the AUA guidelines reviewed the evidence from an individual perspective, not from a public health perspective, Dr. Carter explained. “The point of the guidelines is to help urologists inform an average-risk man who is asymptomatic.”
The AUA guidelines are “not a response” to the USPSTF or any other guidelines, he noted. The process for drawing up the AUA guidelines began 2 years ago. It was based on a rigorous systematic literature review by a multidisciplinary team, involving medical and radiation oncologists, general internists, epidemiologists, and urologists, he said.
Do Not Screen in These Groups
The AUA guidelines state that PSA screening is not recommended for men younger than 40 years, for men 40 to 54 years who are at average risk, for men 70 years and older, and for men with a life expectancy of less than 10 to 15 years.
It is recommended that men in these age groups (younger than 55 years or 70 years and older) who are at a higher risk for prostate cancer (e.g., because of a family history of disease or by virtue of their race) speak to their physician about the benefits and risks of PSA testing.
“There is less evidence here of benefit,” Dr. Carter said, but these men who are at higher risk need to know the benefits and harms of screening, he added.
The new AUA guidelines supercede and replace the section on prostate cancer detection in the 2009 AUA best-practice document, which recommended that screening start at age 40. That document was based on opinion and clinical evidence, whereas these new clinical guidelines are based on evidence from a systematic literature review, Dr. Carter explained.
In the new guidelines, “our statements do not go beyond the evidence,” he said. The quality of the evidence for benefit was moderate (grade B), whereas the quality of the evidence for harm was high (grade A),” he noted. “The panel felt that it would not be reasonable to go beyond the evidence and make statements based on opinion.”