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PSA Screening Guidelines Stir Debate

American Urological Association Calls for PSA Screening at Age 40 to Help Detect Prostate Cancer

New Guidelines Address Concerns of Overtreatment

Carroll counters that earlier baseline PSA testing should lead to less screening because most patients will not need annual follow-up testing.

Other changes in the AUA guidelines reflect efforts to address the issue of overdetection and overtreatment, he says.

These changes include:

  • The group no longer recommends a single PSA value at which a biopsy is recommended. Instead, predictors of risk, including family history, patient age, and ethnicity, should be considered in addition to PSA and physical exam results, Carroll says.
  • For the first time, the guidelines clearly state that going without treatment is an acceptable option for patients with a positive prognosis. The strategy involves close monitoring, with treatment reserved for patients who show evidence of cancer progression.

Now known as "active surveillance," the approach has long been popular in Europe but has not been widely embraced in the U.S.

Carroll is a prostate cancer researcher at the University of California, San Francisco. "In this country, the detection and treatment of prostate cancer have been tightly linked," he says. "When we stop linking them, I believe that many of the objections to PSA testing will fall by the wayside."

Urologist Ira Sharlip, MD, who is also with the University of California, San Francisco, tells WebMD that he is comfortable recommending active surveillance to his patients who have a low risk for progression. His patients who opt for no treatment receive digital rectal exams and PSA blood tests every three months, with repeat biopsies performed every year or two.

"I personally think the limited information we have on active surveillance suggests that it is safe, but this has not been proven," he says.

One thing everyone who spoke to WebMD agreed on is that men facing decisions about PSA screening need to become educated about the issue.

Kramer recommends visiting the web sites of the National Cancer Institute and the U.S. Preventive Services Task Force.

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