Understanding the New PSA Testing Guidelines

Recently the American Urological Association (AUA) announced new guidelines for prostate specific antigen (PSA) testing.  These guidelines were designed to help urologists, and ultimately patients, reduce prostate cancer mortality by making informed screening decisions.  These recommendations were based on comprehensive literature reviews and the strength of the existing evidence. 

Here is what you need to know:

• The AUA recommends against screening in men under age 40.  Such blanket recommendations can increase the risk of younger men being overlooked and potentially resulting in worse disease later in life. Men under 40 need to be educated about prostate cancer and given a clear understanding of their individual risk factors.   Obesity/excess weight, a family history of prostate cancer, and African American race are the driving risk factors of this disease.
• The AUA recommends against routine screening in men of average risk aged 40 to 54 years old.  Early diagnosis and treatment are the two most important factors to successfully eliminating prostate cancer.
• The AUA strongly recommends careful consideration of the pros and cons of screening for men between the ages of 55 and 69.  The risk of prostate cancer increases significantly by age 65; thus it is wise for men in this age bracket to be screened. These men have the greatest opportunity for early detection and treatment to eliminate their prostate cancer with optimal quality of life.
• The AUA suggests screening for prostate cancer every two years rather than annually. PSA is not a perfect test.  Prostate cancer can be an indolent cancer, taking many years to decades before it causes problems or it can behave in a highly aggressive manner. PSA is not able to differentiate these two cases. However, by tracking PSA velocity and density we can more accurately predict ones risk of cancer.
• The AUA recommends against PSA screening in men over age 70 with a life expectancy less than 10-15 years.  Now that such a large percentage of Americans live well into their 80’s, prostate cancer screening should be part of overall wellness monitoring for these men.

Prostate cancer remains the second leading cancer cause of death in men, killing approximately 34,000 men each year.  Since the widespread adoption of PSA screening in the early 1990’s, there has been a 39% reduction in prostate cancer mortality rates; so there is no doubt that PSA screening is successful – when used correctly.  Speak with your doctor about your individual risk factors for prostate cancer and your treatment goals.  Through comprehensive education about prostate cancer testing, diagnosis, and treatment options, American men can make well-informed decisions and decide what’s best for them.