American Urology Association Changes Position on Routine Prostate Testing

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The American Urological Association, which in recent years has defended the PSA screening test, has changed it’s position and no longer recommends routine testing for men.

On Friday, the American Urological Association (AUA) announced that men under the age of 55 should not get routinely screened with a PSA test [1]. Men who are between the ages of 55 and 69 should talk with their doctors about the benefits and harms of testing and proceed based on their personal values and preferences.

The new guidelines for early detection of prostate cancer were developed using evidence from a systematic literature review rather than consensus opinion, and provides rating and interpretation of the evidence based on randomized controlled trials with modeled and population data as supporting evidence. The AUA panel acknowledged that ongoing research, including studies on biomarkers other than PSA, may lead to changes in the guidelines statements, and announced plans to regularly update the guidelines based on new evidence.

Unlike other types of cancers, prostate cancer is typically a slow-growing cancer. And although cancer develops in the prostate in most men as they age, it causes no trouble for most of them. Autopsy studies of men who died from something other than prostate cancer show that 30% of men over age 50 and 70% of men over age 70 have some cancerous cells in their prostate [2]. The cancers were too small to be detected by biopsy. The development of the PSA test changed this. While the PSA test can detect the presence of cancerous prostate cells, it can’t distinguish between ones that pose no threat to health from those that will.

In May 2012, the U.S. Preventive Services Task Force (USPSTF) — an independent panel of medical experts that advise the government on treatment guidelines — released a recommendation that healthy men should not get routinely screened with a PSA test for prostate cancer, citing a number of harms related to screening and diagnostic procedures [3].

The recent AUA announcement is in sharp contrast from last year, when the organization blasted the Task Force for its recommendation, saying that they were “outraged at the USPSTF’s failure to amend its recommendations on prostate cancer testing to more adequately reflect the benefits of the prostate-specific antigen (PSA) test in the diagnosis of prostate cancer” [4].

The PSA test is used to measure levels of prostate-specific antigen (PSA), a protein produced by the prostate, in the blood. PSA is a biomarker for prostate cancer.

Dr. H. Ballentine Carter, who chaired the panel that developed the guideline, said in a press release [1]:

There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer. The randomized controlled trials are more mature at this point and there is more data available today than there was in 2009. It’s time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms.

To further reduce the harms of cancer screening, for those men who have decided on screening, the AUA guidelines suggest a routine screening interval of two years or more instead of an annual screening to preserve the majority of screening benefits and reduce over diagnosis and false positives.

The guidelines do not recommend routine PSA screening in men over age 70 or any man with less than a 10-15 year life expectancy.