Prostate Specific Antigen Best Practice Statement: 2009 Update
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.
Requests for reprints: Guidelines Department, American Urological Association, 1000 Corporate Blvd., Linthicum, Maryland 21090.
⁎ Financial and/or other relationship with Takeda.
† Financial and/or other relationship with Blue Cross/Blue Shield, GlaxoSmithKline, National Cancer Institute, Agency Health Care Quality, Aureon Corportion, Sanofi, Ikonysis.
‡ Financial and/or other relationship with Endocare, Gen-Probe.
§ Financial and/or other relationship with Calypso Medical.
¶ Financial and/or other relationship with AstraZeneca, Sanofi-Aventis, GlaxoSmithKline.
∥ Financial and/or other relationship with Ismar Medical, Ismar Healthcare.
⁎⁎ Financial and/or other relationship with National Cancer Institute, AstraZeneca, Takeda.
ABSTRACT