In an attempt to clarify what it calls conflicting guideline statements on prostate cancer screening from various organizations, the Large Urology Group Practice Association (LUGPA) has issued its own position on the use of the PSA test as a screening tool.
“Unfortunately, these conflicting statements have resulted in confusion amongst both our patients and fellow physicians,” said Deepak A. Kapoor, MD, president of LUGPA. “It should be made clear that a PSA test is simply a tool that facilitates informed decision making; it is neither a commitment to have a biopsy nor an obligation to receive treatment should prostate cancer be detected.”
According to a LUGPA press release, after careful evaluation of previously published guidelines and thorough review of recent statements from the European Association of Urology and the Prostate Cancer World Congress, the LUGPA Board of Directors, in consultation with thought leaders in the diagnosis of prostate cancer, unanimously adopted the following official position on PSA screening:
Risks of prostate cancer screening must be uncoupled from risks of prostate cancer detection and treatment.
PSA testing facilitates the early detection of prostate cancer, which results in a reduced risk of being diagnosed with or developing locally advanced and/or metastatic prostate cancer, and a reduction in prostate cancer-specific mortality.
A baseline serum PSA level should be obtained in men in their 40s who have made an informed decision to pursue early detection of prostate cancer.
Intervals for an individual’s prostate cancer screening should be adapted to: baseline PSA, prostate cancer risk factors (including African-American heritage and a family history of prostate cancer), and the potentially short preclinical timeline of aggressive cancers.
PSA screening should be offered to men with a life expectancy of greater than or equal to 10 years, regardless of age.
PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection.
This is the best recommendation I have seen from any medical entity to help diagnose prostate cancer for men whose life has a high chance of being impacted by the disease.