Harvard Men's Health Watch

In the journals: Urologists update PSA guideline

In May 2013, the American Urological Association (AUA) has issued an update to its 2009 guideline to doctors on which men should be screened for prostate cancer with the prostate-specific antigen (PSA) blood test. Screening means checking men without symptoms of prostate cancer for signs of hidden disease. The goal of screening is to catch cancer early, when it is hypothetically less advanced and more responsive to treatment. Ideally, screening should prevent death from the disease, not just diagnose it earlier. The downside of screening is that it can identify prostate cancers that would never have threatened health or longevity—and lead to treatments that therefore will have no benefits but that may have adverse effects, such as incontinence and erectile dysfunction.

Here are the highlights of the AUA guideline, which are consistent with recommendations already issued by other medical organizations, including the American Cancer Society and the U.S. Preventive Services Task Force:

AUA 2013 PSA guidelines

Screening is not recommended for men younger than 40.

Routine screening is not recommended for men 40 to 54 at average risk, but men in this age range could consider screening if they have risk factors such as a family history of prostate cancer or African American heritage.

Men 55 to 69 may benefit from screening, but should first discuss the risks and benefits with their physicians. The best research to date suggests says that screening 1,000 men ages 55 to 69 every two to four years for a decade prevents one death from prostate cancer.

Men who understand the risks and benefits of PSA could extend the testing interval to once every two to four years, instead of annually.

Screening is not generally recommended for men older than 70 or who have an expected lifespan less than 10 to 15 years. However, men over 70 in excellent health may still benefit from screening.

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