Blog Updates for March 2009

Mar 27/09. In Screening and Early Protection. Part 3 - Current Environment we added: In response to two studies on PSA testing the president of the AUA stated: "The American Urological Association has read with great interest the coverage surrounding the two studies about prostate-specific antigen (PSA) testing recently published in the New England Journal of Medicine, and is concerned about the alarm these two studies have raised with patients. The decision to screen for prostate cancer is a personal one that a man should make in conjunction with his physician or urologist. Because most cancers need to be caught in their earliest stages to achieve the best outcome for the patient, disparaging the PSA test puts men - particularly with certain risk profiles - at risk for life-threatening disease. Prior to the use of the PSA test, tumors were found mostly in advanced - and less treatable - stages, giving patients far fewer options for treatment. These studies, as well as the 2008 United States Preventive Services Task Force recommendation that men stop PSA testing after the age of 75, have potential for harm if they are not explained clearly to patients or reviewed in the context of the full debate on PSA. It is the opinion of the AUA that the PSA test is a valuable screening tool that saves lives - and men with concerns about elevated PSA scores should consult their urologists about next steps.

These two studies do not clearly assert that PSA testing causes more harm than benefit. In one of the two studies, 52 percent of men in the "non-screened" arm had recent PSA tests, thus enriching the non-screened arm with men who had normal PSA levels and reducing the chance for prostate cancer death in this arm of the study. This means that more than half of the men in the non-screening arm of the study were screened, making it difficult to demonstrate a difference. In the other study, there was actually a 20 percent reduction in death from prostate cancer with a relatively short follow-up of only nine years. This is an important point. The benefit of screening may not be demonstrable until significantly longer follow up is reached for both trials. These studies therefore do not lead to the conclusion that PSA screening should be abandoned.

Men who are concerned about these studies should talk with their urologists about their particular risk profile and whether regular PSA testing is best for them.

The AUA is presently finalizing a new Best Practice Statement about prostate-specific antigen testing that will be unveiled during our upcoming Annual Meeting. These studies are being addressed in more detail in the Statement, but do not change the AUA's position that PSA is a valuable screening tool and should be appropriately offered to men. This document will be made available to the public in April." [link].

Also: The following statement was issued by the AUA Foundation on March 19, 2009 and is attributable to AUA Foundation Executive Director Sandra Vassos, MPA:

The American Urological Association Foundation (AUA Foundation) is concerned that two major studies about prostate-specific antigen (PSA) testing may present conflicting information to patients about the value of this critical prostate-cancer screening test. The benefits of regular screening and early detection should not be discounted in the overall population. The decision to screen for prostate cancer with PSA and digital rectal examination should incorporate other known risk factors, including family history of prostate cancer, age, ethnicity/race, and whether or not the individual has had a previous negative prostate biopsy.

Men should understand that studies such as these are just a part of the overall national discussion about PSA testing. An overwhelming body of evidence exists that supports the value of this test and that screening has the potential to save lives. The AUA Foundation strongly believes that the decision to screen is one that a man should make in conjunction with his physician and supports the screening recommendations of the American Urological Association. The Association is expected to release a new best practice statement about PSA testing during the group's upcoming Annual Scientific Meeting in Chicago next month. [link]

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March 13/09. In ED After Prostatectomy. Part 2 - Rehabilitation we add: John Mulhall has recently written a patient-oriented book.