March 27, 2014 14:32 ET

The Future of the PSA Test and Prostate Cancer Diagnosis

Lenox Hill Hospital Robotic Prostate Surgeon, David Samadi, MD, Says Decreased Screening Can Increase Late Stage Prostate Cancer Diagnosis

NEW YORK, NY--(Marketwired - Mar 27, 2014) - A recent study finds that use of the prostate-specific antigen (PSA) test is on the decline, a trend believed to be the result of recommendations from the United States Preventative Services Task Force (USPSTF) and the American Urological Association (AUA). In 2012 and 2013 respectively, the groups issued recommendations to reduce routine PSA testing based on concerns about the over-screening and overtreatment of prostate cancer.

"Screening fewer men or screening less often has the potential to increase the incidence of late-stage prostate cancer diagnoses," said David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital. "Early diagnosis helps avoid some of the risks associated with diagnosing prostate cancer after symptoms appear."

Current AUA guidelines for PSA testing:

  • Men under age 40: PSA screening not recommended
  • Men between the ages of 40 and 54: Routine PSA screening not recommended unless at higher risk based on family history or African American race
  • Men between the ages of 55 and 69: Shared decision-making between provider and patient is recommended; if testing is elected, a 2-year interval is suggested
  • Men over age 70: Routine PSA testing is not recommended unless life expectancy is greater than 10-15 years

The PSA blood test is often the first step in a two-part prostate cancer screening process that also includes the digital rectal exam (DRE). Since the PSA is not prostate-cancer specific, abnormal results are explored further through a prostate biopsy.

In reviewing PSA usage from 2008 to 2012, researchers noted a decline across almost all subgroups of physicians, including internal medicine, family medicine, urology, and hematology/oncology. The most significant drop was seen at an urban teaching hospital among urologists with patients aged 50-59 years. Results were published in The Journal of Urology,

"The AUA panel recommends shared decision-making between provider and patient for this age bracket [55-69], but to see these men drop off the PSA radar is concerning," said Dr. Samadi.

The AUA maintains that PSA testing is valuable for some men, pending a thorough discussion of risk factors and health status with an experienced provider. More specifically, however, they advise against routine testing for most men under age 55 or over age 70. "If we choose to follow the recommendations exactly, we risk misadvising patients. These guidelines may be too limiting for younger men for whom a baseline test is useful and older men for whom screening is still valuable," Dr. Samadi said.

Dr. Samadi and his colleagues at The Prostate Cancer Center at Lenox Hill Hospital in New York work closely with men of all ages to design tailored prostate cancer screening and treatment plans based on the full range of risk factors.

Contact Information