PSA testing and patients at risk: the NCCN speaks

The National Comprehensive Cancer Network (NCCN) has just issued revised guidance on early detection of prostate cancer. The revised guidelines take account of the results of the recent ERSPC and PLCO trials that assessed the benefit of PSA screening. The NCCN Guidelines contend that PSA testing does save lives when performed intelligently in men at high-risk of developing the disease.

In a detailed media release, NCCN has laid out an argument based on the concept that PSA testing is effective and needs to be more rigorously conducted in high-risk populations. The full text of the revised guidance is also available on the NCCN web site. (You do need to register to be able to read this document, but there is no cost involved.) To quote Mark Kawasaki, MD, the chairman of the guidelines committee, “We are most likely to produce further declines in prostate cancer mortality if we focus on younger men who are more likely to die of prostate cancer than other causes and the diagnosing of aggressive prostate cancer in all men.”

This is an opinion that correlates precisely with the position taken by America’s Prostate Cancer Organizations in a statement made earlier this year, when we stated that, “Despite recent data and media coverage about PSA testing and prostate cancer mortality, the early detection and appropriate treatment of clinically significant prostate cancer remains a critical priority, especially among men at high risk because of family history, ethnicity, or other factors that define such risk.”

The following quotations are taken directly from the NCCN’s media release:

“Some of the controversy with the recent trials assessing the benefits of PSA testing stems from people confusing early detection with screening…. It is imperative to distinguish the two terms from each other and understand that screening implies testing a random group of participants where as early detection targets a select group of patients whose need is greatest.”

“It is important to note that the NCCN Guidelines for Prostate Cancer Early Detection are for the purpose of detecting cancer early in high-risk men, not the screening of mass populations.”
“… the current NCCN Guidelines recommend that at age 40, high-risk men be offered a baseline PSA and DRE and if their PSA is 1.0 ng/mL or greater, that they receive annual follow-ups. If their PSA is less than 1.0, the NCCN Guidelines recommend that these men be screened again at age 45.”

“NCCN Guideline Panel Members acknowledge that there is no ‘right’ answer about PSA testing for everyone, but that each man needs to make an informed decision with his physician.”


The “New” Prostate Cancer InfoLink congratulates the NCCN Guideline Panel members for generating an important and helpful new guidance document for physicians and their patients that may assist everyone to be clearer about the continued importance of prostate cancer testing using the PSA test in men who have reason to be concerned about their risk for this disease.

PSA testing and patients at risk: the NCCN speaks"