Monday, April 27, 2009

Prostate Cancer PSA Screening American Urological Association Guidelines

New guidelines for screening for prostate cancer are being presented today at the annual meeting of the American Urological Association. The guidelines have recommendations that make sense and take into account new data from two recent research studies. and for the first time give concrete suggestions in regard to the use of the PSA or prostate specific antigen for screening.

The problem has been that no one has been very clear as to who or who not should be screened. Prostate cancer is the second leading cause of cancer death in men in the United States with approximately 186,00 new cases oer year and 28,000 deaths. But in many cases prostate cancer is indolent or slow growing and may not create significant clinical problems for some men. There have been no markers or screening tests that have been able to determine which men are at risk of dying of the disease and which men aren't. The test used is a blood measurement of the PSA or prostate specific antigen which is expressed by cancer cells but can also be elevated for other reasons. The concern has been that excessive use of this test may result in unnecessary biopsies and unnecessary treatment. Researchers are studying other potential markers for the disease but for now the PSA is all we have. Not screening anyone is tantamount to just giving up at this time and reconciling to the fact that many men are simply going to die of the disease. So no one has really known what to suggest to me regarding screening for prostate cancer.

A PSA level of over 4 nanograms per milliliter has been used as a cutoff value for determining who should get a biopsy. One recent study involving 1,200 men however have shown that men whose initial PSA screening was 1 or less by age 60 have very little likelihood of dying of the disease (less than 1%). A second larger study involving 29,000 men showed that men whose initial screening by age 60 noted PSA values of 1 or 2 or less were at very low risk of developing aggressive disease. So the new recommendations of the American Urological Association are that men be screened at age 40 (the previous recommendation was 50 but many men die of prostate cancer before age 50) and that those whose PSA values are in the top fourth of normal be followed more closely and that those with very low normal PSA values do not need to be screened regularly but only every 5 years or so.

It seems to me these new guidelines strike a good balance between not screening at all and over testing.

Thought for the day

"These three remain, faith, hope, and love but the greatest of these is love".

St. Paul

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