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The American Urological Association (AUA) has published a new guideline on prostate-specific antigen (PSA) screening. The guideline has five summary recommendations:
No screening for men younger than 40.
No “routine” screening for men aged 40 to 54 and at average risk; for those in this age group who are at higher risk (e.g., black men, those with family histories of prostate cancer), individualize screening decisions.
For men aged 55 to 69, engage in shared decision making and proceed based on the man's values and preferences.
No “routine” screening for men older than 70 or men with life expectancy shorter than 15 years.
When screening, consider biennial instead of annual screening.
Carter HB et al. Early detection of prostate cancer: AUA guideline. J Urol 2013 May 6; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.juro.2013.04.119)
Comment
This guideline supplants a 2009 AUA “Best Practice Statement,” which stated that screening “. . . should be offered to healthy, well-informed men 40 years of age or older” (J Urol 2009; 182:2232). The new guideline narrows the age range for “routine” screening to 55 to 69, because that was the core age group in the European screening trial (JW Gen Med Mar 14 2012). Still, the guideline makes for some frustrating reading: Phrases such as “no routine screening” (my italics) are ambiguous, and many clinicians find difficulty in navigating the interplay between a patient's “values and preferences” and the complexity of potential benefits and harms of screening.
Many media reports publicized the new guideline as evidence that urologists are backing off from aggressive PSA screening. However, some urologists have criticized the AUA for not presenting screening more favorably. And finally, this guideline differs substantially from that of the U.S. Preventive Services Task Force, which recommends against PSA screening for all age groups (JW Gen Med Jun 7 2012).