FEATURED JOBS
Comments (1)As you may have been reading over the last year or so, there is a continuing controversy about the utility of PSA when used as a screening tool for prostate cancer. Almost exactly one year ago, we discussed PSA in this blog. Given the continuing questions and arguments, I thought it would be prudent to revisit the issue.
The following is a letter sent to all of the members of the American Urologic Association. I thought that our followers of the Men’s Health Blog would be interested in reading what our association is saying about PSA.
“Dear AUA Member,
As you know, the American Urological Association (AUA) has been monitoring the recent debate about prostate-specific antigen (PSA) testing and actively inserting our position on the topic as needed. On Tuesday, March 9, an op-ed in The New York Times, written by Dr. Richard J. Ablin, inaccurately asserted that the AUA supports routine PSA screening. The article has received significant attention from news outlets around the country and the AUA is working with media outlets to respond.
The AUA stands in support of prostate cancer testing. However, the AUA does not advocate universal annual PSA testing for all men, nor does it support routine biopsy. Research has shown that a PSA above a certain level at age 40 is a stronger predictor of prostate cancer risk than family history or race. The AUA recommends that men ages 40 and older talk to their doctors about prostate health and the pros and cons of establishing a baseline PSA score. Establishing a baseline PSA at age 40 empowers patients and doctors to make informed decisions about future testing. The AUA also clearly states that follow-up should be determined based on a patient’s individual risk and discussions with his doctor.
We feel that the recent debate is inappropriately focused on the PSA test itself, when we should be focusing on how test results are being interpreted and impacting treatment decisions. The 2009 AUA Best Practice Statement on Prostate-specific Antigen presents a balanced assessment of the test’s strengths and weaknesses and provides comprehensive guidance on how to appropriately interpret test results based on a patient’s individual risk factors.”
This is essentially the way that I have been practicing for the last number of years and I suspect that most of my colleagues have a similar practice as well. In medicine, much as in many other places, the pendulum tends to swing in arcs that are rather large. At first PSA was thought to be the “wonder lab,” and now there are many doctors (mostly primary care) who feel that PSA is not a particularly good test. Truth as always, lies somewhere in the middle. There is no question that the use of PSA has helped to identify prostate cancer in many at a much earlier stage and the evidence shows that because of this prostate cancer death has decreased. But like anything, PSA is not perfect and it is best utilized by a knowledgeable physician and an informed patient.
Have a great weekend. Go Terps!
