Prostate Specific Antigen Best Practice Statement: 2009 Update

Greene, Kirsten L.; Albertsen, Peter C.; Babaian, Richard J.; Carter, H. Ballentine; Gann, Peter H.; Han, Misop; Kuban, Deborah Ann; Sartor, A. Oliver; Stanford, Janet L.; Zietman, Anthony; Carroll, Peter

doi:10.1016/j.juro.2009.07.093

« Previous Next »The Journal of Urology
Volume 182, Issue 5 , Pages 2232-2241, November 2009

Prostate Specific Antigen Best Practice Statement: 2009 Update

Kirsten L. Greene
- Financial and/or other relationship with Takeda.
Peter C. Albertsen
- Financial and/or other relationship with Blue Cross/Blue Shield, GlaxoSmithKline, National Cancer Institute, Agency Health Care Quality, Aureon Corportion, Sanofi, Ikonysis.
Richard J. Babaian
- Financial and/or other relationship with Endocare, Gen-Probe.
H. Ballentine Carter
Peter H. Gann
Misop Han
Deborah Ann Kuban
- Financial and/or other relationship with Calypso Medical.
A. Oliver Sartor
- Financial and/or other relationship with AstraZeneca, Sanofi-Aventis, GlaxoSmithKline.
Janet L. Stanford
Anthony Zietman
- Financial and/or other relationship with Ismar Medical, Ismar Healthcare.
Peter Carroll
- Financial and/or other relationship with National Cancer Institute, AstraZeneca, Takeda.

American Urological Association Education and Research, Inc., Linthicum, Maryland

published online 23 September 2009.

Purpose

We provide current information on the use of PSA testing for the evaluation of men at risk for prostate cancer, and the risks and benefits of early detection.

Materials and Methods

The report is a summary of the American Urological Association PSA Best Practice Policy 2009. The summary statement is based on a review of the current professional literature, clinical experience and the expert opinions of a multispecialty panel. It is intended to serve as a resource for physicians, other health care professionals, and patients. It does not establish a fixed set of guidelines, define the legal standard of care or pre-empt physician judgment in individual cases.

Results

There are two notable differences in the current policy. First, the age for obtaining a baseline PSA has been lowered to 40 years. Secondly, the current policy no longer recommends a single, threshold value of PSA, which should prompt prostate biopsy. Rather, the decision to proceed to prostate biopsy should be based primarily on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities.

Conclusions

Although recently published trials show different results regarding the impact of prostate cancer screening on mortality, both suggest that prostate cancer screening leads to overdetection and overtreatment of some patients. Therefore, men should be informed of the risks and benefits of prostate cancer screening before biopsy and the option of active surveillance in lieu of immediate treatment for certain men diagnosed with prostate cancer.

Key Words: prostatic neoplasms, prostate-specific antigen, mass screening, neoplasm staging, treatment outcome

Abbreviations and Acronyms: AUA, American Urological Association, BPH, benign prostatic hyperplasia, CT, computerized tomography, DRE, digital rectal examination, ERSPC, European Randomized Study of Screening for Prostate Cancer, MRI, magnetic resonance imaging, NCI, National Cancer Institute, PCPT, Prostate Cancer Prevention Trial, PLCO, The Prostate, Lung, Colon, and Ovary Trial, PSA, prostate specific antigen, PSADT, PSA doubling time, PSAV, PSA velocity, TZPSAD, transition zone PSA density