BALTIMORE (February 22)--Physicians should consider a biopsy to confirm a prostate cancer diagnosis when a prostate specific antigen (PSA) test reading is at least 4.0 ng./ml., the PSA level of a patient significantly increases from one test to the next, or a digital rectal examination (DRE) is abnormal, according to a Best Practice Policy released today by the American Urological Association.
The policy report, which was developed by a multi-disciplinary panel of physicians, was released as an article in the February issue of the journal Oncology. Medical disciplines represented on the panel included urology, internal medicine, family practice, gerontology, and radiation oncology. Beginning on March 1, the entire policy will be available on the Internet at www.cancernetwork.com .
According to the policy, prostate specific antigen (PSA) testing detects more prostate cancers than digital rectal examinations and it detects them earlier, but the two procedures should be used in conjunction with each other. "PSA currently is the best single test for early prostate cancer detection; but the combination of PSA and DRE is better because DRE will detect some of the tumors in some of those patients who have prostate cancer despite a normal PSA," the policy says.
The AUA policy also says that decisions regarding early detection of prostate cancer should be individualized and benefits and consequences should be discussed with the patient before PSA testing occurs. Generally, the AUA recommends that all men who have at least a 10-year life expectancy should be offered regularly scheduled prostate cancer testing beginning at age 50. In situations of men at increased risk, such as African-Americans and those with a history of prostate cancer in their families, the testing should be offered at an earlier age.
According to the report, the dramatic increase in prostate cancer detection between 1986 and 1991 is usually credited to the increasing use of PSA testing. Of prostate cancers currently detected, about 75 percent are associated with an abnormal PSA.
"The goal of early detection is to identify patients who have clinically significant prostate cancers, cancers that are at an early stage when treatment is most likely to be effective," the Best Practice Policy says. While the goal of PSA testing is to detect clinically significant prostate cancers at an early stage, the report recognizes that non-significant tumors also are detected.
Prostate cancer is the most common form of non-skin cancer in United States men, and it is the second leading cause of male cancer mortality with approximately 30,000 deaths each year.
In addition to detecting prostate cancer, the AUA Best Practice Policy discusses how the PSA test can play an important role in pre-treatment staging of prostate cancer, thereby eliminating many expensive and invasive radiologic and surgical staging procedures.
The AUA policy also addresses periodic PSA testing to detect disease recurrence. Cancer that has spread beyond the prostate to other parts of the body tends to be characterized by PSA levels that fail to fall to undetectable levels after surgery or rise despite radiation or cryotherapy; rise within 12 months of all forms of local treatment; or double in less than six months.
"What this Best Practice Policy report does is distill the myriad of data about PSA down to a short, easy to digest balanced document on what we know about the subject relating to the diagnosis, staging, and management of prostate cancer," says Dr. Ian Thompson of the University of Texas, San Antonio Medical Center, who chaired the American Urological Association committee that produced the policy. "The report cuts to the quick of what we actually know about the PSA test, thereby helping to eliminate many commonly performed procedures used to diagnose, stage, and monitor prostate cancer."
The PSA Best Practice Policy is the first developed by the American Urological Association. These consensus-based, multi-disciplinary statements focus on issues that lack adequate data to formulate evidence-based guidelines and in which multiple medical disciplines are involved.
With more than 12,000 members worldwide, the American Urological Association, Inc.--an educational nonprofit 501(3)(c) organization--is the largest and most prestigious professional association for urologists.
NOTE TO JOURNALISTS: The complete copy of the AUA Prostate Specific Antigen Best Practice Policy Report and other background information on prostate cancer is available by contacting Bill Glitz by phone at (703) 532-3797, by fax at (703) 532-0835, or by e-mail at wglitz@aol.com or Lisa Goetz by phone at (410) 223-6402, by fax at (410) 223-4369, or by e-mail at lgoetz@auanet.org . You also can arrange interviews with members of the committee that developed the best practice policy.
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Oncology