Prostate Cancer Screening Controversy: “Smart” Use of PSA

A recent article published in the Journal of Clinical Oncology suggests Prostate-specific antigen (PSA) levels in midlife predict subsequent development of lethal prostate cancer.

  W. Bedford Waters, MD, former President of the American Board of Urology (ABU), Chief in the Division of Urology, and a Urologist at The University of Tennessee Medical Center (UTMC), says the prostate screening controversy continues. “Since the US Preventive Services Task Force recommended against PSA screening for men of all ages in 2012, early data suggests that this has been associated with a reduction in the diagnosis of low-risk disease, but that the proportion of high-risk disease has increased. We need to have a balance and do smarter screening. This paper adds to the growing body of knowledge that a one-size-fits-all approach to prostate cancer screening ignores the large variation in prostate cancer risk. Incorporating the information from this paper into our screening protocols will help us individualize prostate cancer screening in the future.”  Currently UTMC recommends the following for prostate cancer screening:

  • Obtain a baseline PSA at 40 – 45 years of age in patients with a family history of prostate cancer, or if the patient is African-American. If the PSA is < 0.5 ng/ml, that patient can be screened every two to three years.
  • Screening is not recommended for patients if they have less than a 15 year life expectancy or have many medical co-morbidities.
  • The AUA Guidelines recommend that clinicians discuss the pros and cons of the PSA test with men who are 55 to 69 years of age. For those men being screened, the AUA recommends 2-year PSA intervals, with longer intervals for men over 60 with PSA levels
  • There is no consensus on screening over the age of 70, one has to look at the total patient, his overall health, and co-morbidities. Some men over 70 years of age who are in excellent health might also benefit from screening, but the risk of harm increases and the chance of a benefit decreases with age.

For more information about The University of Tennessee Medical Center’s prostate cancer program or to schedule an appointment, visit University Prostate and Urology Cancer Center, or call 865.305.6970.

Want to join us in raising awareness for prostate cancer?  Register to attend the 9th Annual Man Run!  Saturday August 27, 2016.