New AUA Recommendation: Start Offering PSA Testing at 40

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CHICAGO—The American Urological Association (AUA) recommends that PSA testing should be offered to well-informed men aged 40 years and older who have a life expectancy of at least 10 years.

This recommendation, which contrasts with guidelines issued by other medical organizations, is part of a new AUA Best Practice Statement unveiled at the association's annual meeting here. It updates the AUA's previous PSA testing recommendations, which were issued in 2000.

“The single most message of this statement is that prostate cancer testing is an individual decision that patients of any age should make in conjunction with their physicians and urologists,” said Peter Carroll, MD, who chaired the panel the developed the new recommendations.

In the updated guidelines, the AUA said it does not recommend a single PSA threshold at which a biopsy should be performed. The decision to biopsy should take into account other factors, including free and total PSA, PSA velocity and density, patient age, family history, race and ethnicity, prior biopsy histories, and co-morbidities. The AUA statement emphasizes that not all prostate cancers are life threatening and not all require active treatment.

In addition, the AUA statement clarifies key points related to the use of PSA in selecting treatment and in post-treatment follow up:

  • Serum PSA predicts prostate cancer response to local therapy;
  • Routine bone scans are not required for staging asymptomatic men with clinically localized cancer when their PSA level is 20 ng/mL or less;
  • Periodic PSA testing should be offered to detect cancer recurrence;
  • Serum PSA should decrease and remain at undetectable levels following radical prostatectomy;
  • Serum PSA should fall to a low level after radiotherapy, high-intensity focused ultrasound, and cryotherapy and should not rise on successive occasions.
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