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Earlier Prostate Specific Antigen Testing Suggested

Best practice statement suggests starting at 40, basing biopsy decision on variety of factors

TUESDAY, Nov. 10 (HealthDay News) -- The optimal use of prostate specific antigen (PSA) for early detection of prostate cancer, risk stratification, and post-treatment management is the focus of an article published in the November issue of The Journal of Urology.

Kirsten L. Greene, M.D., of the American Urological Association Education and Research Inc. in Linthicum, Md., and colleagues provide a summary of the association's 2009 best-practice policy for the use of PSA testing.

The association now recommends baseline PSA testing at 40 instead of 50. One reason for this change is that PSA is more specific for cancer in younger men due to the lower likelihood of confounding from prostate enlargement. The association also discourages basing biopsy decisions on a single threshold PSA value. This decision should be based on digital rectal exam, patient's age and family history, ethnicity, free and total PSA, and PSA velocity and density. Clinicians should discuss with patients the risks of overdetection of prostate cancer and the role of active surveillance as a treatment option.

"Assessment of serum PSA plays important roles in the detection and assessment of prostate cancer. The updated guidelines reflect information to date. It is recognized that they will need to be revised in a timely fashion based on new information, which is likely to accrue rapidly. It is also clear that new serum, tissue and germline markers will be developed which will complement or may even replace serum PSA for the applications reviewed in this update," the authors conclude.

Several co-authors reported financial or other relationships with pharmaceutical companies and other entities.

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