PSA and new guidelines for Prostate cancer screening by American Urological Association (AUA)
On May 03, 2013, AUA issued a new guideline for Prostate cancer screening. The purpose of this guideline is to reduce prostate cancer related mortality by addressing early detection of Prostate cancer. The AUA panel recommend against PSA (Prostate Specific Antigen) screening in men < 40 years because there is low prevalence of clinically detectable Prostate cancer and there is no evidence showing benefit of PSA screening. Furthermore, they also do not recommend routine PSA screening in men ages 40-54 years at average risk. If these men are at high risk (e.g. positive family history or African American race) then PSA screening should be individualized. The greatest benefits of screening seems to be for men ages 55 –69 years and panel strongly recommend for shared decision making for PSA screening in these age group. For men who decided for screening, screening interval of 2 years is preferred over annual screening in order to reduce harms of screening like overdiagnosis and false positives. Lastly, the AUA panel does not recommend routine PSA screening for men ages >70 years or for any men with life expectancy of less than 10-15 years. This new guideline is based on evidence from systemic literature reviews and replaces the previous AUA guidelines.
I think this new guideline is a fine balance between over and under screening. I hope that with these recommendations, more and more patients will be benefited from PSA screening and at the same time the potential harms from it can be minimised.