The American Urological Association (AUA) sent the following additional message to its members with the past 90 minutes(May 6, 2013) :
Dear AUA Member,
On Friday, May 3, the AUA released a new clinical guideline on the Early Detection of Prostate Cancer. The new guideline has been in development for nearly two years and was peer reviewed by more than 50 AUA members prior to being approved by the AUA’s Board of Directors. While much of the media coverage concerning the guidelines has been accurate, some outlets have mistakenly stated that the AUA has changed its position and is now recommending against prostate cancer screening in all men at risk for this common disease. In fact, this is not at all what the guidelines state. Compared to our 2009 best practice policy document, the guidelines do narrow the age range in which informed decision making around PSA screening should be offered to men at average risk for prostate cancer, but they do not make a blanket statement against screening, as some have implied. Importantly, the guidelines only apply to men at average risk. The guidelines do not apply to symptomatic men or those at high risk for disease (men with a family history or of African-American race), who are encouraged to discuss their individual case with their doctor, regardless of their age.
Acknowledging this, there are some changes that have been made to the guidelines in response to recent new studies on screening. Specifically, in men age 40-54 at average risk for the disease, the guidelines recommend that screening, as a routine practice, should not be encouraged. Simply put, the evidence for the benefit for screening in this age range was limited while the quality and strength of the evidence regarding the harms of screening was high. This does not mean that we are recommending AGAINST screening; it simply means that there is insufficient evidence to support routine screening in this population at this time.
The other key change is in men over age 70 or those with less than a 10-year life expectancy in whom routine screening is not recommended. However, the guidelines acknowledge that some men over age 70 in excellent health may benefit from screening. In this setting, the guidelines suggest that a discussion of the unique risks and benefits of screening in older men occur.
The highest quality evidence for benefit (defined as lower prostate cancer mortality) of screening was found in men ages 55 to 69, and this evidence demonstrated that one man per 1,000 screened at 2- to 4-year intervals will avert a prostate cancer death over a decade. However, over a lifetime, this benefit could be much greater.
In men age 55-69, the guidelines still strongly recommend shared decision-making and screening based on a man’s values and preferences. The only difference here is that the guidelines now recommend biennial screening to reduce the potential harms of screening.
Additionally, it should be noted that the AUA remains in disagreement with the U.S. Preventive Services Task Force in recommendation against prostate cancer screening in all men, regardless of age or risk, without even considering a discussion of the risks and benefits of screening. The AUA continues to support a man’s right to be tested for prostate cancer — and to have his insurance pay for it, if medically necessary.
The AUA is in the process of preparing supplemental materials that urologists can share with primary care providers in their communities, and will be working with major patient advocacy groups to ensure that patient education materials are available. More information about these tools will be available in late May; the toolkit will be available on AUAnet.org.
http://prostatecancerinfolink.net/2013/05/06/further-comment-from-the-aua-on-new-psa-screening-guidance/
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