Transcript ADVANCE DIRECTIVES 101 - Prostate Health Education Network

Willie Underwood, III, MD, MS,MPH
AUA Guidelines, PHEN 9-24-09
Prostate-Specific Antigen Best
Practice Statement: 2009 Update
Prostate cancer is the most common noncutaneous
cancer in men in the United States (US).
Despite its prevalence, the natural history of this
disease is remarkably heterogeneous.
In many patients, the cancer progresses slowly,
resulting in tumors that remain localized to the
prostate gland.
Although potentially life-threatening, such cancers are
most often curable.
Many patients with low grade and volume cancers may be
candidates for active surveillance.
In other patients, however, tumor growth may be more
rapid, resulting in cancer spreading beyond the confines
of the prostate.
In such cases, long-term survival may be considerably
diminished compared to survival associated with organconfined cancers.
Strategies for managing prostate cancer have therefore
been aimed at early detection, with selective, tailored
treatment.
Given the uncertainty that PSA testing results in more
benefit than harm, a thoughtful and broad approach to
PSA is critical.
Patients need to be informed of the risks and benefits of
testing before it is undertaken.
The risks of over-detection and over-treatment should be
included in this discussion.
Because there is now evidence from a randomized,
controlled trial regarding a mortality decrease associated
with PSA screening, the AUA is recommending PSA
screening, for well-informed men who wish to pursue
early diagnosis.
The AUA
recommends that all discussions of
treatment options include active
surveillance as a
consideration, since many screen-detected
prostate cancers may not need immediate
treatment.
Men in their 40s with a PSA value above the
median (0.6 to 0.7 ng/mL) are at 30 higher
risk for prostate cancer.
Fang, J., Metter, E.J., Landis, P., et al: Low levels of prostate-specific
antigen predict longterm
risk of prostate cancer: results from the Baltimore Longitudinal Study
of Aging.
Urology, 58: 411, 2001
Loeb, S., Roehl, K.A., Antenor, J.A., et al: Baseline prostate-specific
antigen compared with median prostate-specific antigen for age group as
predictor of prostate cancer risk in men younger than 60 years old.
Urology, 67: 316, 2006