SAN DIEGO—Updated American Urological Association (AUA) guidelines for prostate cancer screening, which were announced at the group’s annual meeting, recommend that men aged 55-69 who are considering PSA screening should talk with their doctors about the benefits and harms of testing and proceed based on their personal values and preferences.
In addition, the new guidelines, which update the AUA’s 2009 Best Practice Statement on Prostate-Specific Antigen, do not recommend screening in men under age 40 and do not recommend routine screening men aged 40 to 54 at average risk.
To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in men who have participated in shared decision-making and decided to be screened Compared with annual screening, it is expected that screening intervals of two years preserve the majority of benefits and decrease overdiagnosis and false positives.
Routine PSA screening also is not recommended for men older than 70 years or any man with less than a 10-15 year life expectancy.
According to AUA, the new guidelines differ significantly from previous statements in that they were developed using evidence from a systematic literature review rather than consensus opinion. The highest-quality evidence for screening benefit (lower PCa mortality) was for men aged 55-69 years screened at two- to four-year intervals. Data showed that one man per 1,000 screened will prevent a PCa death over a decade. The panel that developed the guidelines acknowledged that ongoing research, such as studies on biomarkers other than PSA, may lead to changes in the guidelines.