New AUA Prostate Cancer Screening Guidelines

We are happy to provide a link to the AUA's (American Urologic Association) latest prostate cancer screening guidelines. Just visit the site and you can download a copy of their guidelines brochure.

I would like to note that the guidelines recommend an annual PSA for men beginning at 40, along with a DRE (digital rectal exam). Although I am not a physician and do not provide medical advice, I suggest that men have a Free PSA test if their PSA test comes back positive. I say this because in my case my two tumors were located on top of the prostate where they could not be felt by DRE. Fortunately, my urologist requested a Free PSA test (your Free PSA value should be equal to or greater than .25 (25%) of your total PSA, and the tumors were detection prior to metastasis. If your Free PSA/total PSA is less than .25, it is an indication that a tumor may be present and you should consult your physician. If you do not have a physician (and you should!), you can obtain these tests on your own from an independent laboratory.

Remember, it is not the absolute PSA value that matters most, but the change from year-to-year. Should your PSA value change approximately .75 or more from one year to the next, you should see a physician immediately.

Want a little adventure in your life? Join us for all or part of the 2010 Tour de USA for prostate cancer awareness or join us on the Tour de Skyline Drive this August 22-24.

Due Your Own Due Diligence!

The controversy over the utility of the PSA for lowering the prostate cancer continues, which is a good thing because it hopefully will draw men's attention (better yet, draw women's attention) to the critical importance of annual testing.
While some members of the medical community continue to comment about "over treating" prostate cancer, approximately 29,000 men die each year in the US from the disease, and the incidence rate for prostate cancer in the 20-49 year cohort is increasing. Spend a few minutes at the National Cancer Institute's online database (Surveillance Epidemiology and End Results) at http:/seer.cancer.gov/faststats and you will see how much we do not know about this disease - the most current data set is three years old. What I believe it shows is that early detection (note that the PSA test came into use in the early 1990s) has increased the rate of detection and lowered the death rate. The worrying aspect is the continuing rise in PCa incidence in young adult males.
You can find an interesting article about the PSA testing controversy in the online version of the San Francisco Chronicle on this issue at . The author, himself a prostate cancer survivor and the CEO of Soar BioDynamics Ltd., makes the point that rather than discarding the PSA test perhaps we should be using it as part of a more comprehensive diagnostic process. Prostate cancer is still the most common male cancer is the US and is the number two cancer killer in men. Prostate cancer is not the harmless, indolent disease that it is often portrayed. One in every six men will be stricken with disease - perhaps more if the trends in the SEER continue. If you read this post, I like to hear your comments. If you know a man who is 35 or older and not testing, encourage them to begin. Test. Track. Treat. Live.(TM)

The AUA Weighs in on the PSA Testing Discussion

The AUA released the following statement on March 26, 2009. As noted, the statement is attributal to Dr. John Barry, AUA president. As a prostate cancer survivor focused on early detection and treatment, this seems a very balanced statement. Your comments?

AUA STATEMENT ABOUT PROSTATE-SPECIFIC ANTIGEN TESTING

The statement below is attributable to Dr. John Barry, president of the American Urological Association. This statement is being issued in response to two studies recently published in the New England Journal of Medicine about prostate-specific antigen (PSA) testing.

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.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 15,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients, including UrologyHealth.org, an award-winning on-line patient education resource, and the American Urological Association Foundation, Inc.