UroToday - AUA 2008 - Clinical Guideline: PSA

[Guest guest]

Wednesday, 21 May 2008

ORLANDO, FL

(UroToday.com) - Dr. Greene presented the PSA guidelines. The 2008 guidelines

are an update from 2000. They performed a comprehensive literature review, had

panel members review the articles then review them again under panel peer

review. The consensus opinion is presently under final review. She presented

the preliminary report.

It is a

long process, as there are no prospective, randomized, controlled trials

showing a survival benefit to CaP screening. The screening controversy is

ongoing, but the NCCN, the AUA and the ACS support screening. Completion of

screening trials in Europe and the US will facilitate the appropriate

conclusions.

In 2000,

age 50 was used to start screening, but age 40 is now being considered. The

biopsy threshold was 4.0ng/ml, but a continuum of risk with a range of PSA is

being considered. PSAV may be a better indicator of risk compared to an

absolute value. African-American men should have screening earlier and PSA is

more sensitive in younger men. Prostate volume, complexed PSA, free/total PSA,

PSAD and PSA isoforms are under consideration. Risk stratification tables may

facilitate a patient’s decision regarding screening and biopsy. All these

factors rather than a threshold value will be considered in the upcoming

guidelines.

Presented by Kirsten L. Greene, MD, at the Annual

Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County

Convention Center - Orlando, Florida, USA.