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AUA Counters Mainstream Recommendations with New Best Practice Statement on Prostate-Specific Antigen Testing
Date:4/27/2009

arroll, MD, chair of the panel that developed the Statement. "But the bottom line about prostate cancer testing is that we cannot counsel patients about next steps for cancer that we do not know exist." He also notes that "the AUA is committed to the timely, expert and appropriate care for men either with or at risk of getting prostate cancer and is prepared to revise these guidelines continuously as new information becomes available."

Additionally, the Best Practice Statement clarifies a number of key points about the use of PSA in treatment selection and post-treatment follow up of prostate cancer patients:

  • Serum PSA predicts the response of prostate cancer to local therapy.
  • Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA level is equal to or less than 20.0 ng/mL.
  • Computed tomography or magnetic resonance imaging scans may be considered for the staging of men with high-risk clinically localized prostate cancer when the PSA is greater than 20.0 ng/mL or when locally advanced or when the Gleason score is greater than or equal to 8.
  • Pelvic lymph node dissection for clinically localized prostate cancer may not be necessary if the PSA is less than 10.0 ng/mL and the Gleason score is less than or equal to 6.
  • Periodic PSA determinations should be offered to detect disease recurrence.
  • Serum PSA should decrease and remain at undetectable levels after radical prostatectomy.
  • Serum PSA should fall to a low level following radiation therapy, high intensity focused ultrasound and cryotherapy and should not rise on successive occasions.
  • PSA nadir (low point) after androgen suppression therapy predicts mortality.
  • Bone scans are indicated for the detection of metastases following initial treatment for localized disease
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SOURCE American Urological Association
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