NCCN guidelines stress importance of PSA testing in high-risk men

In high-risk men, PSA testing performs optimally when conducted intelligently and combined with prompt, effective, high-quality treatment, according to updated clinical practice guidelines on early detection of prostate cancer from the National Comprehensive Cancer Network.

NCCN said the new guidelines follow in the wake of recent confusion that ensued after the publication of two PSA screening trials: the European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Guidelines panel members stressed that testing is effective and needs to be more rigorous in high-risk populations.

"Some of the controversy with the recent trials assessing the benefits of PSA testing stems from people confusing early detection with screening," said guidelines panel chair Mark Kawachi, MD, of the City of Hope Comprehensive Cancer Center, Los Angeles. "It is imperative to distinguish the two terms from each other and understand that screening implies testing a random group of participants, where as early detection targets a select group of patients whose need is greatest."

The NCCN pointed out that the guidelines are for the purpose of detecting cancer early in high-risk men, not the screening of mass populations. The guidelines emphasize this point with a note in the introduction stating that they are specifically for men opting to participate in an early detection program after receiving appropriate counsel.

An additional update to the NCCN guidelines is a higher PSA (1.0 ng/mL) that would prompt high-risk men to receive more frequent screenings. Therefore, the current NCCN guidelines recommend that at age 40, high-risk men be offered a baseline PSA and digital rectal exam, and if their PSA is 1.0 ng/mL or greater, that they receive annual follow-ups. If their PSA is less than 1.0 ng/mL, the guidelines recommend that these men be screened again at age 45.