The AUA’s list identified the following five recommendations:
A routine bone scan is unnecessary in men with low-risk prostate cancer.
Do not prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.
Do not order creatinine or upper tract imaging in men with BPH.
Do not treat an elevated PSA with antibiotics for patients not experiencing other symptoms.
Do not perform ultrasound on boys with cryptorchidism.
The AUA has made recommendations on several areas. There were two that were important for men in the area of prostate cancer.
Men with early stage prostate caner do not need a routine bone scan. During my training at Indiana University from 1997-2003 this was the standard of care in my residency. Historically, all men with prostate cancer had a bone scan and CT scan. Both of these are not necessary for men with low grade prostate cancer. I have not ordered routine bone scans since coming to west Orange, NJ in 2003.
The other important recommendation was in the treatment of an elevated PSA with antibiotics. This is the first time I have seen the AUA make the recommendation. If men have stable urinary symptoms and no inflammatory (WBC) cells in the urine, antibiotics should not be prescribed. I have been practicing in this fashion my entire career, but many physicians including urologists would often prescribe antibiotics to see if an elevated PSA would return to normal values.