New AUA Guidelines for Prostate Cancer Screening

The American Urological Association (AUA) released a new clinical guideline detailing recommendations for the use of prostate cancer screening in average-risk men based upon evidence from a systematic literature review. The guideline, which was announced during the 2013 AUA Annual Meeting, recommends that men aged 55 to 69 years who are considering undergoing prostate cancer screening should talk with their physicians about the benefits and risks of screening.

“The new AUA guideline is a high-quality set of recommendations based on a systematic review of the literature, and a nuanced analysis of available data,” said Ethan Basch, MD, MSc, director of cancer outcomes research at the University of North Carolina’s Lineberger Comprehensive Cancer Center. “This is a leap ahead in terms of methodological quality.”

Specifically, the guidelines are based on evidence-based randomized clinical trials with modeled and population data as supporting evidence. This is in contrast to guidelines issued by panels based on consensus opinion.

The new guideline states that PSA screening in men aged younger than 40 years is not recommended. In addition, routine prostate cancer screening was not recommended in men aged between 40 and 54 years.

After the release of the guideline, the AUA issued an additional statement clarifying this new recommendation.

“Simply put, the evidence for the benefit for screening in this age range was limited, while the quality and strength of the evidence regarding the harms of screening was high,” the statement read. “This does not mean that we are recommending against screening; it simply means that there is insufficient evidence to support routine screening in this population at this time.”

Dr. Basch, who was also co-chair of the American Society of Clinical Oncology’s PSA Screening Guideline Panel, said that the evidence in this area is a “bit equivocal,” but added that “in the absence of definitive data, their conclusion that harms likely outweigh risks is reasonable.”

The new guideline does not recommend routine PSA screening in men aged older than 70 years or in men with a life expectancy less than 10 to 15 years, a recommendation similar to those released by ASCO.

Shared decision-making is recommended for men aged 55 to 69 years that are considering PSA screening. In addition, it is recommended that men in this age group undergo screening every 2 years to reduce potential harms of screening. According to the AUA statement, the highest quality of evidence for screening benefit was in men aged 55 to 69 years screened at 2-year to 4-year intervals. Among this group, data showed that one man per 1,000 screened will avert prostate cancer death during a decade.

“A challenge with both the AUA and ASCO recommendations to use shared decision-making is that the data are very complicated, and there aren't a lot of decision aids out there that can be efficiently used at the point of care,” Dr. Basch told Cancer Network. “Both guidelines point to the ASCO decision aid, but this is an area where we need research and more tools.”

According to the statement, the AUA is in the process of preparing supplemental materials that urologists can share with primary care providers in their communities, and will be working with major patient advocacy groups to ensure that patient education materials are available.

Overall, the AUA stated that it continues to support a man’s right to be tested for prostate cancer and to have his insurance pay for it, if medically necessary.