–By. Dr. David W. Hall, M.D.
The current controversy surrounding routine prostate cancer screening is a common concern for physicians and patients. When and if to use the PSA (prostate specific antigen) blood test for screening has been the primary focus of the ongoing controversy. Although many patients are aware that there is controversy, they do not understand why, or what position they should take. Each medical organization seems to have their own viewpoint or guideline on routine prostate cancer screening, making the topic very confusing for the general public and patients.
On May 6th, 2013, in conjunction with the American Urological Association’s (AUA) annual meeting, the AUA released new prostate cancer screening guidelines. The new guidelines recommend a more targeted screening approach that is broken down based on age and risk factors. A “one-size-fits-all” routine PSA screening program is no longer recommended.
Below I have described the five main points presented in the AUA’s new prostate cancer screening guidelines to help you better understand the recommendations.
1. The AUA does not recommend conducting prostate cancer screening in men under 40 years of age. The risk of identifying clinically significant prostate cancer in this age group is low, and there is no evidence supporting any benefit to screening.
2. Routine screening is not recommended in average risk men between the ages of 40-54. For higher risk men in this age group, such as African American men or men with a family history of prostate cancer, screening decisions should be discussed and tailored individually.
3. For men between the ages of 55-69, the AUA recommends thoughtful discussion regarding the potential risks and benefits of screening. The panel also recommends placing more value on patient preference to undergo prostate cancer screening or not. The greatest benefit to screening, however, appears to be in this age group.
4. Rather than the traditional annual screening regimen, screening intervals of two years or more may be prudent once risk has been assessed and shared-decision making has taken place. This recommendation is based on the desire to decrease the risks of screening (i.e., over detection and false-positives) while maintaining the benefit of early detection.
5. The AUA does not recommend routine prostate cancer screening in patients over 70 years of age or in men with a life expectancy less than 10-15 years. This is the statement that I have seen misinterpreted the most. The key word in this recommendation is “routine”. I have seen other groups and news agencies state that the new guidelines call for absolutely no prostate cancer screening in males over 70 years of age. This is an inaccurate interpretation of the guidelines. There should be no routine screening, but clearly, in today’s society, there are plenty of healthy, elderly men over 70 with a life expectancy greater than 15 years, who may benefit from screening. The decision to screen should be individualized and not performed routinely.
As you can see, prostate cancer screening is an increasingly controversial and confusing topic. The best way to approach it is to have a thorough discussion with your doctor. You need to review your overall health, your family history, your life expectancy, your prostate cancer risk, and the potential risks and benefits of screening. The days of a “one-size-fits-all” approach to prostate cancer screening are gone. Prostate cancer screening now involves proper risk assessment, thoughtful discussion, and shared decision making between doctor and patient.
—Dr. David W. Hall, M.D. is founder of My Urology Doc (aka MUD) and is the primary content crafter for all of it’s social media outlets. Utilizing MUD, he is currently helping over 3 K followers in over 55 countries make the choice to get involved in their urologic healthcare. He is also continuing to provide the best urologic care possible in the communities of Fishers, Indiana and New Castle, Indiana. Follow him on twitter at @myurologydoc.