LUGPA, an organization advocating for integrated and coordinated urological care with more than 2,000 physician experts across the U.S., has been carefully monitoring the recent controversy surrounding the use of prostate-specific antigen (PSA) testing for early detection of prostate cancer. Despite high-level evidence for the use of PSA testing as a screening tool and its role as a predictor of future risk, several conflicting guideline statements have been released from various organizations.
“Unfortunately, these conflicting statements have resulted in confusion amongst both our patients and fellow physicians,” said Dr. Deepak A. Kapoor, President of LUGPA and Chairman and CEO of Integrated Medical Professionals, PLLC. “It should be made clear that a PSA test is simply a tool that facilitates informed decision making; it is neither a commitment to have a biopsy nor an obligation to receive treatment should prostate cancer be detected.”
After careful evaluation of previously published guidelines as well as thorough review of recent statements from the European Association of Urology and the World Prostate Cancer Congress, the LUGPA Board of Directors, in consultation with thought leaders in the diagnosis of prostate cancer, unanimously adopted the following as LUGPA’s official position on PSA screening.
1. Risks of prostate cancer screening must be uncoupled from risks of prostate cancer detection and treatment
2. PSA testing facilitates the early detection of prostate cancer, which results in:
a. a reduced risk of being diagnosed with or developing locally advanced and/or metastatic prostate cancer
b. a reduction in prostate cancer-specific mortality
3. A baseline serum PSA level should be obtained in men in their 40s who have made an informed decision to pursue early detection of prostate cancer
4. Intervals for an individual’s prostate cancer screening should be adapted to:
a. baseline PSA
b. prostate cancer risk factors (including African-American heritage and a family history of prostate cancer)
c. the potentially short preclinical timeline of aggressive cancers
5. PSA screening should be offered to men with a life expectancy of ≥ 10 years, regardless of age
6. PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection
Demographic data clearly demonstrates that we are not detecting more cancers; we are detecting prostate cancer earlier and thus saving lives. Despite the progress of the last two decades, prostate cancer remains the second leading cause of cancer death in men in the United States, with African-American men and those with a family history of prostate cancer at the greatest risk of developing this disease.
“Prostate Cancer Awareness Month is observed in September – this is a good time to remind men to have an open discussion with their physician about their individual risk factors for prostate cancer, and determine if PSA testing is right for them,” continued Kapoor. “As the clinicians whose specialty is dedicated to the appropriate diagnosis and treatment of prostate cancer, urologists must remain steadfast in protecting the rights of men and their caregivers to appropriately access PSA testing.”
LUGPA represents 121 large urology group practices in the United States, with more than 2,000 physicians who make up more than 20 percent of the nation’s practicing urologists. LUGPA and its member practices are committed to best practices, research, data collection and benchmarking to promote quality clinical outcomes. For more information, visit lugpa.org.
Karen Moore, APR, CPRC