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New Clinical Guideline on Prostate Cancer Screening
Men aged 55 to 69 years who are considering prostate cancer screening should talk with their doctors about the benefits and harms of testing and should proceed based on their personal values and preferences, according to a new clinical practice guideline issued by the American Urological Association (AUA).
The new guideline, which updates the AUA’s 2009 Best Practice Statement on Prostate-Specific Antigen (PSA), was announced during the 2013 AUA Annual Meeting in San Diego, California. The guideline does not address the detection of prostate cancer in symptomatic men, where symptoms could be related to locally advanced or metastatic disease.
The highest-quality evidence for a screening benefit (i.e., lower prostate cancer mortality) was in men aged 55 to 69 years who were screened at 2- to 4-year intervals; the data demonstrated that one man per 1,000 screened will avert a prostate cancer death over one decade. However, over a lifetime, this benefit could be much greater. Further, men outside this target age range (55 to 69 years) could benefit from screening because they are at a higher risk of prostate cancer due to factors such as race and family history. These men should discuss their risk with their physicians and assess the benefits and risks of testing, the AUA says.
The new guideline makes the following statements:
- PSA screening in men under the age of 40 years is not recommended.
- Routine screening in men aged 40 to 54 years with an average risk is not recommended.
- For men aged 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in one man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men in this age group who are considering PSA screening, and they should proceed based on their values and preferences.
- To reduce the harms of screening, a routine screening interval of 2 years or more may be preferred over annual screening in men who have participated in shared decision-making and have decided on screening. Compared with annual screening, it is expected that screening intervals of 2 years will preserve most of the benefits and will reduce over-diagnosis and false positives.
- Routine PSA screening is not recommended in men over the age of 70 years or in any man with less than a 10- to 15-year life expectancy.
Source: AUA; May 3, 2013.