At the end of the American Urological Association conference in Chicago on April 28, its conveners announced that the AUA's year 2000 standard of practice for all men 50 and over to get the PSA test should now be lowered to age 40 and up. This is an overt endorsement of the PSA test, despite its deficiencies, providing patients are likely to live at least another ten years.
It seems to me this reflects the reality that biomarker research advances are still experimental and inconclusive. As such the urologists at the AUA’s spring 2009 meeting in effect concluded that the PSA is still the most reliable test we have. Once the patient’s PSA level is tested, it’s to be determined if a biopsy is warranted, and in turn if some treatment option(s) are called for.
When urging PSA testing at age 40 for all men, and not just those at high risk (such as African Americans or men whose fathers or brothers had prostate cancer), the AUA was careful to point out that men, in conjunction with their urologists, should consider active surveillance as one of several treatment options they might choose.
This new AUA position is a clear endorsement of the PSA test despite the medical dispute that has raged this past month over its value. To me it confirms that not knowing your PSA level is worse than knowing what it is, to be followed by a biopsy (if indicated) and by determining what treatment, if any, is best. In short, if we want to determine that a man might have prostate cancer, we should not contend that “Ignorance is bliss.”
Sure, many men will continue to rush into surgery despite a slow-growing prostate cancer, rather than take a wait and see approach. On the other hand many others will continue to decry PSA, biopsies and surgery or radiation as blatant, costly overtreatment. Such disagreements are inevitable and will continue as long as scientists don’t come up with better alternatives.
Current studies of mice and a few men are insufficient to set aside the PSA test and the digital rectal exam (DRE). What's called for are large-scale, randomized studies of new, proposed biomarkers that are evidence-based and apply to men wherever they live.