Men ages 55 to 69 who are considering prostate cancer screening should talk with their doctors about the benefits and harms of testing and proceed based on their personal values and preferences, according to a new clinical practice guideline released by the American Urological Association (AUA). The new guideline, which updates the Association’s 2009 Best Practice Statement on prostate-specific antigen (PSA) was announced during the 2013 AUA Annual Meeting in San Diego. The guideline does not address detection of prostate cancer in symptomatic men, where symptoms imply those that could be related to locally advanced or metastatic prostate cancer.
The new guideline is significantly different from previous guidance as it was developed using evidence from a systematic literature review rather than consensus opinion, provides rating and interpretation of the evidence based on randomized controlled trials with modeled and population data as supporting evidence, and develops statements that do not go beyond the available evidence. In developing the guideline, the panel acknowledged that ongoing research may lead to changes in the guidelines statements, and announced plans to update the guidelines regularly based on new evidence.
Key Recommendations
The guideline makes the following specific statements:
- PSA screening in men under age 40 years is not recommended.
- Routine screening in men between ages 40 to 54 years at average risk is not recommended.
- For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years who are considering PSA screening, and proceeding based on patients’ values and preferences.
- To reduce the harms of screening, a routine screening interval of 2 years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of 2 years preserve the majority of the benefits and reduce over diagnosis and false-positives.
- Routine PSA screening is not recommended in men over age 70 or any man with less than a 10- to 15-year life expectancy. ■
