The American Urological Association (AUA) Best Practice Statement has recently updated its prior recommendation from 2000 now suggesting that urologists start offering patients PSA testing beginning at age 40 years. This is in contrast with a number of other medical organizations who disagree.
“Prostate-specific antigen (PSA) levels are significantly lower in aspirin users with latent prostate cancer than in similar patients who are not aspirin users,” say Vanderbilt University “scientists who caution that aspirin may affect prostate cancer detection.”
The U.S. Preventive Services Task Force recently recommended that men age 75 years and older and men under age 75 with chronic medical problems and a life expectancy of fewer than 10 years not be screened for prostate caner (Ann Intern Med 2008; 149:185-91). This report received a lot of attention in the lay press; however, it is not new. Most in the urologic community have been making this same recommendation for the last 20 years. The key word here is screening. Screening specifically refers to asymptomatic men without significant risk factors for prostate cancer. Only about 10% of men older than 75 years will die of cancer and only 9% of men age 85 or older can expect to live 10 years or longer. This recommendation does not mean that men with a suspicious digital rectal exam, or significant new or continued voiding problems, should not have their PSA checked.