Introduction: The AUA PSA Screening Guidelines

Panelists: David Albala, MD, Crouse Hospital; E. David Crawford, MD, University of Colorado ; Raoul S. Concepcion, MD, Urology Associates, PC; Vahan Kassabian MD, Georgia Urology; Steven E. Finkelstein, MD, 21st Century Oncology; Stephen J. Freedland, MD, Duke; and David I. Quinn, MD, USC
Published Online: Wednesday, December 18, 2013
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Moderator, Raoul S. Concepcion, MD, introduces a panel discussion focused on guidelines and the many new treatments recently approved for castration-resistant prostate cancer. The goal of the discussion is to provide urologists with a range of expert perspectives on current challenges that affect both patients and practices. The conversation includes input from David Albala, MD, E. David Crawford, MD, Vahan Kassabian MD, Steven E. Finkelstein, MD, Stephen J. Freedland, MD, and David I. Quinn, MD.

The exchange begins with a discussion of the recent American Urological Association (AUA) guidelines on PSA testing. The guidelines have traditionally recommended that men age 40, if they’re African American or have a family history of prostate cancer, should be screened with a digital rectal examination and a PSA test, says Albala. In the update, the AUA now recommends screening for men age 55 to 69 who do not have risk factors for prostate cancer.

For the updates, the AUA looked toward data showing an improvement in survival as a result of screening, notes Freedland, who served as a member of the guideline decision panel. In the European Randomized Study of Screening for Prostate Cancer the core group of men studied were 59 to 69 years old with PSA testing done every four years. In this study, there was a clear connection between screening and a reduction in prostate-specific deaths, notes Freedland. However, the data for men age 40 to 54 was less clear. As a result, recommendations were not made for screening men in this age range.

These guidelines sparked controversy, since they followed a decision from the USPSTF to give PSA testing a D recommendation, Concepcion states. This decision was largely based on a fear that men diagnosed by PSA screening were being overtreated.

There is a clear need to separate diagnosis from treatment, Freedland says. However, when you examine actual practice patterns, at this time diagnosis and treatment are synonymous, with approximately 90% of patients with low-risk disease receiving treatment. As a result of this reality, current guidelines were based on current practice patterns, Freedland suggests.

The ability to separate diagnosis and treatment is rooted in the conversation between a physician and each patient, Albala believes. It is important, just like with every blood test, that the patient understands the implication of the results.
View More From This Discussion
Episode 1 Introduction: The AUA PSA Screening Guidelines
Episode 2 Melbourne Consensus Statement on PSA Screening
Episode 3 Case Study: Prostate Cancer Screening
Episode 4 Multiparametric MRI for Prostate Cancer Diagnosis
Episode 5 3D Transperineal Prostate Mapping Biopsies
Episode 6 Treating High-Risk Localized Prostate Cancer
Episode 7 Optimizing ADT in High-Risk Prostate Cancer
Episode 8 LHRH Agonists Versus Antagonists in Prostate Cancer
Episode 9 Intermittent Versus Continuous ADT in Prostate Cancer
Episode 10 Preventing Skeletal-Related Events in Prostate Cancer
Episode 11 Prechemotherapy Treatment Strategies in CRPC
Episode 12 Early Detection of Metastatic Prostate Cancer
Episode 13 Radium-223 in CRPC With Bone Metastases
Episode 14 Multidisciplinary Prostate Cancer Care
Episode 15 AR-Targeted Therapies in Advanced Prostate Cancer
Expert Panelists
Raoul Concepcion Moderator

Raoul S. Concepcion, MD

Urologists in Cancer Care, Director of Clinical Research
Urologic Surgeon
Urology Associates, PC
Nashville, TN

David Albala, MD

Medical Director,
Associated Medical Professionals; Chief of Urology, Crouse Hospital
Syracuse, New York

E. David Crawford, MD

Professor, Surgery and Radiation Oncology, Head, Urologic Oncology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado

Steven E. Finkelstein, MD

National Director, 21st Century Oncology, TRC
Scottsdale, Arizona

Stephen J. Freedland, MD

Associate Professor of Surgery, Associate Professor in Pathology, Duke University School of Medicine, Durham, North Carolina

Vahan Kassabian, MD

Medical Director
Georgia Urology
Atlanta, Georgia

David I. Quinn, MD, PhD

Associate Professor of Medicine, Medical Director, University of Southern California Norris Cancer Hospital, Los Angeles, California

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