Willie Underwood, III, MD, MS,MPH AUA Guidelines, PHEN 9-24-09

Prostate-Specific Antigen Best Practice Statement: 2009 Update Prostate cancer is the most common noncutaneous cancer in men in the United States (US). Despite its prevalence, the natural history of this disease is remarkably heterogeneous. In many patients, the cancer progresses slowly, resulting in tumors that remain localized to the prostate gland. Although potentially life-threatening, such cancers are most often curable.

Many patients with low grade and volume cancers may be candidates for active surveillance. In other patients, however, tumor growth may be more rapid, resulting in cancer spreading beyond the confines of the prostate. In such cases, long-term survival may be considerably diminished compared to survival associated with organ-confined cancers. Strategies for managing prostate cancer have therefore been aimed at early detection, with selective, tailored treatment.

Given the uncertainty that PSA testing results in more benefit than harm, a thoughtful and broad approach to PSA is critical. Patients need to be informed of the risks and benefits of testing before it is undertaken. The risks of over-detection and over-treatment should be included in this discussion. Because there is now evidence from a randomized, controlled trial regarding a mortality decrease associated with PSA screening, the AUA is recommending PSA screening, for well-informed men who wish to pursue early diagnosis.

The AUA recommends that all discussions of treatment options include active surveillance as a consideration, since many screen-detected prostate cancers may not need immediate treatment.

Men in their 40s with a PSA value above the median (0. 6 to 0 Men in their 40s with a PSA value above the median (0.6 to 0.7 ng/mL) are at 30 higher risk for prostate cancer. Fang, J., Metter, E.J., Landis, P., et al: Low levels of prostate-specific antigen predict longterm risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging. Urology, 58: 411, 2001 Loeb, S., Roehl, K.A., Antenor, J.A., et al: Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. Urology, 67: 316, 2006

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