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Somewhat recently the USPSTF released guidelines for Prostate cancer screening which gave PSA testing a D rating as a screening exam.
The Urologic community is very concerned that the new guideline will change the established practice pattern of screening men age 50 yrs. to 70 yrs. of age.
As a result the AACU (American Association of Clinical Urologist) have released a statement urging primary care physicians to consider the following
In the pre-PSA era 25% of men diagnosed with prostate cancer were found to have cancer already spread beyond the prostate (i.e. metastatic and incurable)
In the post PSA era less than 5% have metastatic disease at the time of diagnosis
Furthermore, the USPSTF recommendation downplayed the impact of prostate cancer mortality.
Men do die from prostate cancer; it is the second leading cause of male cancer deaths, and evidence supports that screening does save lives.
Here are some very important thoughts, facts and concerns you should be aware of regarding the early detection of prostate cancer that you will need to help make the appropriate decision regarding PSA screening:
1) No urology experts were part of the USPSTF
2) PSA is not a perfect cancer test; far from it, yet its value in early detection is still worth a very important discussion,
3) We believe that the early detection of prostate cancer with PSA testing continues to offer value with benefits and lives saved
On May 3rd 2013The AUA (American Urologic Association) our governing body released
The following reviso to the PSA screening guidelines
1) The highest quality evidence for benefit (defined as lower prostate cancer mortality) of screening was found in men ages 55 to 69, and this evidence demonstrated that one man per 1,000 screened at two- to four-year intervals will avert a prostate cancer death over a decade. However, over a lifetime, this benefit could be much greater.
2) The other key change is in men over age 70 or those with less than a 10-year life expectancy in whom routine screening is not recommended. However, the guidelines acknowledge that some men over age 70 in excellent health may benefit from screening. In this setting, the guidelines suggest that a discussion of the unique risks and benefits of screening in older men occur.
3) The AUA remains in disagreement with the U.S. Preventive Services Task Force in recommendation against prostate cancer screening in all men, regardless of age or risk, without even considering a discussion of the risks and benefits of screening. The AUA continues to support a man's right to be tested for prostate cancer and to have his insurance pay for it, if medically necessary.
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