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New PSA Guidelines

Winter 2014 | Page 6

Who hould ave the PSA est?

In 2011, a U.S. Preventive Services Task Force recommended against using PSA testing as a way to screen for prostate cancer. Recently, the American Urology Association (AUA) issued new guidelines for PSA testing. We asked urologist Robert Mordkin, MD, FACS, a member of the Virginia Hospital Center Physician Group, what men should know about these new guidelines.

What is PSA?

PSA stands for prostate-specific antigen, a substance produced in the prostate. PSA levels are determined through a blood test and an elevation may suggest the presence of prostate cancer. The test is not, however, prostate cancer specific.

What are the limitations of PSA testing?

PSA screening is certainly not a perfect test. It is relatively inaccurate and can lead to unnecessary biopsies. Out of all patients who have “abnormal” PSA test results, less than onethird will ultimately have prostate cancer. That means that if all men with abnormal PSA results have a prostate biopsy, at least two-thirds of them do not have cancer.

Under the new AUA guidelines, who benefits most from PSA testing?

For men at average risk of prostate cancer, the greatest benefit of PSA testing appears to be for men between the ages of 55 and 69 years. (See chart next page). Men are considered to be at higher risk if they have a family history of prostate cancer (father, grandfather, brother, uncle) or are African American. The decision about having a PSA test should be made after a discussion between the patient and physician about the pros and cons of screening.

What do you tell your patients about PSA testing?

I talk to them about the known limitations of PSA testing, particularly the fact that it is not cancer specific. Because prostate cancer is the number two cancer killer of men, there is nothing wrong with having a PSA test if a patient is concerned, wants to be screened and understands the shortcomings of the test.

Are there any new tests to screen for prostate cancer?

All urologists would enthusiastically welcome a better, more accurate prostate cancer test to replace the PSA. Thus far, however, this does not exist but there is ongoing research to develop a better screening tool. In our practice, we are using the Prostarix™ urine test, which identifies certain metabolites in urine that may be associated with prostate cancer. While this and other tests show some promise, they do not yet replace the PSA test. We use it in addition to the PSA test to help us assess the potential risk of prostate cancer.

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To schedule an appointment with Dr. Robert Mordkin, call 703.717.4200. For more information, visit www.washingtonurology.com
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AUA PSA Screening Guidelines
  • Under age 40
    PSA screening is not recommended.
  • Ages 40-54 at average risk
    Routine PSA screening is not recommended.
  • Under age 55 at higher risk (family history or African American)
    The decision for screening should be individualized.
  • Ages 55-69
    The greatest benefit of screening appears to be in this age group. Men are strongly urged to consider PSA screening in accordance with their values and preferences. For those who choose to be screened, routine screening every two years is preferable to annual screening.
  • Ages 70-plus
    Routine PSA screening is not recommended. (Some men age 70-plus who are in excellent health may benefit from prostate cancer screening).
  • With a life expectancy of less than 10-15 years
    Routine PSA screening is not recommended.

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