The panel also limited its focus to asymptomatic men. The recommendations do not address prostate cancer detection in men who have symptoms suggestive of locally advanced or metastatic prostate cancer, such as new-onset bone pain or neurologic symptoms involving the lower extremities.

Within the narrowly defined scope of the evidence review, the guideline panel came away with five principal recommendations:

  Recommendation against PSA screening in men

<40, influenced by the low prevalence of clinically detectable prostate cancer and absence of evidence demonstrating a benefit in this age group
Routine screening not warranted in average-risk men 40 to 54, noting that individualized decision making is appropriate for high-risk men younger than 55 (such as African Americans)
A strong recommendation for shared decision making about PSA testing in men 55 to 69, the group for which screening appears to offer the greatest benefit
The option to screen appropriate patients at intervals of 2 years or more, as determined by discussion of the risks and harms, and the option for individual rescreening on the basis of baseline PSA values
Recommendation against routine screening for men ≥70 and men of any age who have a life expectancy less than 10 to 15 years

Comparing and contrasting the recommendations with the AUA’s prior statement is less informative than comparing the recommendations to the position adopted by the United States Preventive Services Task Force (USPSTF), which has recommended against routine PSA testing for men of any age, according to J. Stuart Wolf, MD, chair of the AUA practice guidelines committee.

“The USPSTF basically told providers not to offer PSA testing,” Wolf, of the University of Michigan in Ann Arbor, told MedPage Today. “The main message of [the AUA] guideline is that PSA testing should be offered to the appropriate candidates.”

In an interview last year, USPSTF chair Virginia A. Moyer, MD, of Baylor College of Medicine in Houston, pointed out that the task force recommendations are targeted to primary care physicians, not urologists or other specialists. At the outside, the authors of the AUA guideline acknowledge that the document “addresses prostate cancer early detection for the purpose of reducing prostate cancer mortality with the intended user as the urologist.”

Throughout the guideline, the AUA emphasizes the need for careful discussion of benefits and harms with each patient before making a decision to proceed with PSA testing, even among men ages 55 to 69.

“We recognize that this discussion is not an easy one to have for the physician who isn’t prepared, as there are a lot of complicated issues,” Wolf said. “The AUA has developed decision-making tools that patients and physicians can use to help in this discussion, and the AUA is supporting efforts to publicize the availability and use of these tools. But certainly the discussion needs to take place.”

The complete guideline is available on the AUA website.

Primary source: American Urological Association
Source reference: Carter HB, et al “Early detection of prostate cancer: AUA guideline” AUA 2013.