Dr. Konety discusses the prostate cancer guideline recommendations on screening

In this video, Badrinath R. Konety, MD, MBA, discusses what the American Urological Association prostate cancer guideline recommends in regard to screening. Konety is a member of the AUA prostate cancer guideline committee and the president of Allina Health Cancer Institute in Minneapolis, Minnesota.

Video Transcript:

Initial screening for prostate cancer, just like in the previous iteration, we stress again that shared decision making is key. It's not that the prostate cancer screening is automatic in every person; there has to be a shared decision making, understanding the risks entailed by such screening. It's like opening a Pandora's box; once you start screening, potentially there's a drive to take action, especially if the screening results suggest that there is a risk for prostate cancer by an elevated PSA. That may trigger a biopsy, which may potentially have a risk for complications, which may subsequently also trigger consideration of treatment, which should be judiciously used. You don't want to obviously overtreat people who don't need treatment, and undertreat those who need it. There is some discussions that have to be had there. But I think it's important upfront to make the patient aware that if they could, there's controversy about prostate cancer screening. This man can or cannot undergo prostate cancer screening based on their own preferences and risk assessment, and then be aware that if we undertake this path, then there are certain next steps that may emerge that they will have to make additional decisions in a thoughtful manner.

We also said that the age to initiate screening previously was 55 to 69. Then we even said 50 could be okay. But here, we've lowered the age to initiate screening to 45 to 50 years. Then if somebody has an elevated prostate cancer risk, which obviously is defined as strong family history, Black ancestry, to initiate screening at the age of 40. We've decreased the age of screening, which was one of the big issues that people had with the previous guideline is the age to initiate screening seemed to be rather high. Again, if you read through the guideline document itself, there's lots of basis behind this. It's important.

The other risk factor, we also had to consider is germline mutations, such as BRCA. We felt that there is strong evidence, and it's a strong recommendation to commence screening at age 40 in people who had these risk factors, Black ancestry, germline mutations, and strong family history of prostate cancer, which I think will be a unique and a new mention compared to the previous guidelines. Of course, we recommend PSA be used in the first test for screening for prostate cancer.

We also recommended a screening interval just like in a previous guideline of 2 to 4 years in people who are 50 to 69 years of age. You could also personalize the screening interval based on the patient's risk. [If] you have a high-risk patient, then maybe you want to do a yearly screening interval. Maybe they’re lower risk or standard risk, you can go to a 2 to 4 year screening interval. In people who are getting their first PSA, we strongly recommend to get a complimentary PSA, to get 1 more PSA before you initiate any further action, particularly if they have an elevated PSA. If they have a normal, it's okay, but if you have an elevated PSA on your first screening intervention, then you need to confirm it at least a month out and then see what happens. This is in patients with average risk in particular. Then the DRE, we made it optional. Previous guidelines said the screening intervention consists of PSA and DRE. This time we said just PSA is required, and DRE is optional. That's how we separated the 2 out, based on a lot of strong evidence from the European studies particularly ERSPC.

This transcription has been edited for clarity.