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Updated PSA Screening Guidelines

Robert Mordkin, MD, FACS, is Chief of Urology & Robotic Surgery at Virginia Hospital Center. He graduated from University of Southern California Medical School, completed his internship and urological surgery residency at Georgetown University Hospital, and received advanced training at Duke Medical Center. As an associate professor at Georgetown, he was director of laparoscopic urology and the first urologist in Washington, DC, to perform a laparoscopic prostatectomy.

At its 2013 national annual meeting, the American Urological Association (AUA) issued updated guidelines on PSA screening for prostate cancer detection. Unlike the U.S. Preventative Services Task Force 2011 recommendation against routine PSA testing, the AUA continues to support PSA testing in a more selected population.

Specifically, the new guidelines recommend reducing testing to every other year and to men ages 55–69. Compared to prior statements, this AUA guideline increases the length of time between tests while narrowing the age range for when to start and continue testing. The guideline also emphasizes patient/physician discussion about the beneftts and possible risks of screening. The AUA notes these guidelines apply to men at low risk. Men with a family history of prostate cancer and/or suspicious rectal exam should likely have more regular and earlier PSA testing.

These recommendations are based on the most up-to-date data. Most urologists admit PSA testing is not a particularly accurate way to detect prostate cancer, the second-highest cause of cancer-related death in U.S. men. Efforts to improve testing modalities continue; until such tests are available, the balanced, cautious use of PSA testing and digital rectal exams remains the best approach.

—Robert Mordkin, MD, FACS

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