New consensus: PSA cuts PCa deaths in men 50-69

For men aged 50–69 years, PSA testing reduces prostate cancer-specific mortality and the incidence of metastatic disease, according to a new multinational consensus statement on early detection of prostate cancer, which also calls for prostate cancer diagnosis to be unlinked from treatment for the disease.

The Melbourne Consensus Statement on Prostate Cancer, led by experts at the Prostate Cancer World Congress in Melbourne, Australia last month, includes a set of five consensus statements regarding the use of PSA testing.

“The goal of these statements is to bring some clarity to the confusion that exists with existing guidelines, and to present reasonable and rational guidance for the early detection of prostate cancer today,” according to the consensus statement, which was published as a blog post in the online edition of BJU International (Aug. 7, 2013).

The five consensus statements are as follows:

• For men aged 50–69, level 1 evidence demonstrates that PSA testing reduces prostate cancer-specific mortality and the incidence of metastatic prostate cancer.

• Prostate cancer diagnosis must be uncoupled from prostate cancer intervention.

• PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection.

• Baseline PSA testing for men in their 40s is useful for predicting the future risk of prostate cancer.

• Older men in good health with over 10 year life expectancy should not be denied PSA testing on the basis of their age.

(See the full article online to read the rationale for each of the five statements.)

“An important goal when considering early detection of prostate cancer today, is to maintain the gains that have been made in survival over the past thirty years since the introduction of PSA testing, while minimizing the harms associated with over-diagnosis and over-treatment,” the statement said. “This is already happening in Australia where over 40% of patients with low-risk prostate cancer are managed with surveillance or watchful waiting, and in Sweden where 59% of very low risk patients are on active surveillance.

“However, any discussion about surveillance is predicated on having a diagnosis of early prostate cancer in the first instance… A key strategy therefore is to continue to offer well-informed men the opportunity to be diagnosed early, while minimizing harms by avoiding intervention in those men at low risk of disease progression. This consensus statement provides some guidance to help achieve these goals,” wrote the signatories, including six leading experts from the U.S.: Patrick Walsh, MD, Thomas Ahlering, MD, William C. Catalona, MD, Oliver Sartor, MD, Matthew Cooperberg, MD, MPH, and Stacy Loeb, MD.

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