E-mail this page to a friend!
Health & Medicine for Senior Citizens
New Guidelines Urge Older Men Discuss Benefits,
Harms of Prostate Cancer Screening with Doctor
American Urological Association changes position to
slow wide-spread screening for men 55 to 69; opposes routine screening
of men 40 to 50; no screening if 70+
May 3, 2013 - Men ages 55 to 69 who are considering prostate cancer screening
should talk with their doctors about the benefits and harms of
testing and proceed based on their personal values and preferences,
according to a new clinical practice guideline released today by the
American Urological Association (AUA). The guidelines also say screening in men under 40
or 70 and over is
not recommended, nor is routine screening of men 40 to 50 with
The guideline does not address detection of
prostate cancer in symptomatic men, where symptoms imply those that
could be related to locally advanced or metastatic prostate cancer.
The new guideline, which
updates the Association’s 2009 Best Practice Statement on
Prostate-Specific Antigen (PSA) was announced during the 2013 AUA
Annual Meeting in San Diego, CA.
The new guideline is significantly different
than previous guidance inasmuch as it was developed using evidence
from a systematic literature review rather than consensus opinion;
provides rating and interpretation of the evidence based on
randomized controlled trials with modeled and population data as
supporting evidence; and develops statements that do not go beyond
the available evidence.
In developing the guideline, the panel
acknowledged that ongoing research (including studies on biomarkers
other than PSA) may lead to changes in the guidelines statements,
and announced plans to update the guidelines regularly based on new
The highest quality evidence for screening
benefit (lower prostate cancer mortality) was in men ages 55 to 69
years screened at two- to four-year intervals; data demonstrated
that one man per 1,000 screened will avert a prostate cancer death
over a decade. However, over a lifetime, this benefit could be much
Furthermore, there are men outside this target age range
(55-69 years) that could benefit from screening because they are at
a higher risk of prostate cancer (race, family history, etc.). These
men should discuss their risk with their physicians and assess the
benefits and risks of testing.
The guideline makes the following specific
PSA screening in men under age 40 years is
Routine screening in men between ages 40 to
54 years at average risk is not recommended.
For men ages 55 to 69 years, the decision
to undergo PSA screening involves weighing the benefits of
preventing prostate cancer mortality in 1 man for every 1,000
men screened over a decade against the known potential harms
associated with screening and treatment. For this reason, shared
decision-making is recommended for men age 55 to 69 years that
are considering PSA screening, and proceeding based on patients’
values and preferences.
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. As compared to annual
screening, it is expected that screening intervals of two years
preserve the majority of the benefits and reduce over diagnosis
and false positives.
Routine PSA screening is not recommended in
men over age 70 or any man with less than a 10-15 year life
“There is general agreement that early
detection, including prostate-specific antigen screening, has played
a part in decreasing mortality from prostate cancer,” said Dr. H.
Ballentine Carter, who chaired the panel that developed the
guideline. “The randomized controlled trials are more mature at this
point and there is more data available today than there was in 2009.
It’s time to reflect on how we screen men for prostate cancer and
take a more selective approach in order to maximize benefit and
“The best available evidence suggests that
following these guidelines will lead to an improved benefit-to-harm
Read the complete guideine
About the American
Urological Association: Founded in 1902 and
headquartered near Baltimore, Maryland, the American Urological
Association is a leading advocate for the specialty of urology, and
has more than 19,000 members throughout the world. The AUA is a
premier urologic association, providing invaluable support to the
urologic community as it pursues its mission of fostering the
highest standards of urologic care through education, research and
the formulation of health policy.