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Routine PSA Testing Questioned

Routine PSA Testing for Prostate Cancer Questioned by USPSTF

Recommends that PSA Testing Not Continue as Cancer Screening Tool for Men Under 75

St. Luke's Urologists Respond to the Recommendation

Bethlehem, PA (10/10/2011) - The US Preventive Services Task Force (USPSTF) recommends against the use of prostate-specific antigen (PSA) testing in men under 75 as a prostate cancer screening tool, arguing that the treatment that often follows the test may not be worth the side effects.

Urologists at St. Luke's Center for Urology have responded to these recommendations with the following statements:

Jarrod Rosenthal, MD

“The PSA test has been assailed by critics for several years, but until a suitable alternative becomes available, we believe in the continued use of the test, provided that it is interpreted appropriately. There is no question that many more cancers have been diagnosed because of the availability of the PSA test. The question of whether cancers identified by PSA testing are clinically significant is one that needs to be considered on an individual basis, not by a blanket government mandate that affects all men.”

Frank Tamarkin, MD

“PSA can be a useful screening tool to the practicing urologist. An elevated PSA does not always mean that a patient has cancer, but an elevated PSA, or a rising PSA, combined with physician judgement, and digital rectal examination, can help the patient and physician decide when a prostate biopsy is indicated. I have identified many clinically significant cases of prostate cancer based soley on an elevated or rising PSA. The physician works individually with each patient to determine if PSA testing is appropriate for them based not only on age, but also medical co-morbidities.”

Eric Mayer, MD
Chief of Minimally Invasive Urologic Surgery
St. Luke's Hospital & Health Network

"The PSA test is not the whole issue in the fight against prostate cancer. Instead, the more important focus should be the appropriate clinical interpretation of PSA results. An elevated PSA result or even a diagnosis of prostate cancer does not necessarily warrant immediate treatment. Monitoring patients carefully or conducting a measured intervention based on an open discussion of treatment risks and benefits helps reduce overall morbidity and mortality. Rather than backing away from screening for prostate cancer, the USPSTF results should spur an improvement in the allocation of research dollars to seek out better screening tests and risk assessment tools such as genetic markers in those diagnosed with this potentially lethal disease.”

AUA Responds to New Recommendations on Prostate Cancer Screening

Association urges men to speak with their physicians about the value of prostate cancer testing

Linthicum, MD (10/7/2011) - The American Urological Association (AUA) today released the following statement in response to the U.S. Preventive Services Task Force draft recommendations on the use of the prostate-specific antigen (PSA) test. The statement is attributed to AUA President Sushil S. Lacy, MD:

The American Urological Association (AUA) applauds the U.S. Preventive Services Task Force for its interest in reviewing the use of the prostate-specific antigen (PSA) test. However, we are concerned that the Task Force's recommendations will ultimately do more harm than good to the many men at risk for prostate cancer both here in the United States and around the world. The AUA's current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients.

Not all prostate cancers require active treatment and not all prostate cancers are life threatening. The decision to proceed to active treatment is one that men should discuss in detail with their urologists to determine whether active treatment is necessary, or whether surveillance may be an option for their prostate cancer.

The AUA is currently preparing a new clinical guideline on this topic, and has convened a panel of experts to review not only the use of the PSA test, but also early detection of prostate cancer overall, taking into account the new tests and diagnostics that are becoming available. Until there is a better widespread test for this potentially devastating disease, the USPSTF – by disparaging the test – is doing a great disservice to the men worldwide who may benefit from the PSA test.

For more information about the AUA's position on the early detection of prostate cancer, or to arrange an interview with an expert urologist, please contact the AUA Communications Office at 410-689-3932.

About the American Urological Association

Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 18,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.