Although the American Urological Association (AUA) “applauds” the new guidance statement on prostate-cancer detection issued yesterday by the American Cancer Society (ACS), the two organizations have divergent opinions regarding when baseline screening should begin.
The AUA advocates that all men with a life expectancy of 10 years or more should have baseline PSA testing at age 40, with rescreening intervals determined by the physician. Conversely, the ACS maintains the position it has taken since 1997, advising against a general recommendation for men to undergo screening, instead saying testing should occur only after a man has learned about the limitations and potential benefits of screening and treatment from his health-care provider or a reliable and culturally appropriate other source.
According to the ACS guidelines—updated for the first time since 2001, and available online ahead of print by published online ahead of print in CA: A Cancer Journal for Clinicians:
- Men with a PSA level <2.5 ng/mL can be safely screened once every two years.
- Men with a PSA level >2.5 ng/mL should undergo annual screening.
- Men with a PSA level between 2.5 ng/mL and 4.0 ng/mL should be candidates for individualized risk assessment that incorporates other risk factors for prostate cancer into the referral decision.
- For average-risk men with a PSA level >4.0 ng/mL, that level remains a reasonable threshold for recommending further evaluation or biopsy.
In addition, men at average risk for prostate cancer can wait until age 50 to receive information on the uncertainties, risks, and potential benefits associated with screening. Asymptomatic men with a life expectancy of 10 or more years are not directed to pursue screening at a given age. Rather, states the ACS, they “should have an opportunity to make an informed decision with their health-care provider about screening for prostate cancer” after receiving information about the risks and benefits of such testing.
In its response to the ACS update, the AUA expresses its “full agreement” with the ACS that current early detection strategies need to be refined and better validated, and concurs that informed consent—a centerpiece of the ACS document—is a key component in the decision to undergo testing for prostate cancer. “However,” notes the AUA, “the new ACS statement may not fully characterize the potential benefits of an individualized approach to assessing risk in men considering the risk and benefits of early detection strategies and may cause significant confusion for patients.”