The American Urological Association (AUA) has issued new guidelines for prostate cancer screenings. The guidelines were developed from a systematic literature review to ensure that men most likely to benefit from detection are screened and to encourage shared decision-making between the patient and physician.
The new guidelines state:
- Men 55– 69 years of age who are considering PSA screening should now speak with their physician about the benefits and harms of testing to determine the best course of action.
- PSA screening is not recommended for men <40 years of age, men at average risk between the ages of 40–54 or those >70 years old or with less than 10–15 years life expectancy.
- Men outside the age range of 55– 69 years who are at higher risk of prostate cancer (race, family history, etc.) should still speak to their physician about the benefits and harms of testing.
- To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening.
In 2009, the AUA best practices statement had recommended that men >40 years old (in good health with more than 10–15 years of life expectancy), and men at high risk speak to their physician about prostate-specific antigen (PSA) screening. Unlike the new guidelines, these recommendations were based more on consensus opinion rather than systematic literature review.
PSA screening has played a part in decreasing prostate cancer mortality, but screening without clearly targeting those who are most likely to benefit can result in over diagnosis and treatment, potentially causing more harm than good.
David Bryan, M.D. 's Urology Blog 