Separate PSA Test Guidelines for High Risk and Average Risk Men Needed

November 6, 2013

Thomas A. Farrington, at PHEN's 2012 SummitProstate cancer early detection testing using the PSA test is one of the most controversial subjects in medicine today. This on-going controversy is not good for men who depend on their doctors to provide clear guidance for their prostate health. As a prostate cancer survivor and patient advocate I sometimes sense a lack of urgency to seek solutions to this controversy which is leaving patients confused and at times frantic about what to do. Make no mistake, these patients’ decisions will translate into life or death calls for some, and they deserve clear guidance.

I believe that leaders within the prostate cancer medical profession must work towards ending the PSA test controversy by embracing what is known and accepted while continuing to seek answers for the unknown. During the past two years we have witnessed the widespread acceptance of the concept of prostate cancer overtreatment and active surveillance, along with guidance to discontinue PSA testing for older men with a limited life expectancy. In my view this represents progress towards ending the controversy.

Another area of widespread acceptance is that African American and men with a family history of prostate cancer are at high risk for being diagnosed with the disease, and that African American men die at a rate 2.5 times greater than other men with prostate cancer. It is also well known and accepted by expert researchers in the field that these high risk men were not included in significant numbers within the randomized clinical trials that are the genesis for the ongoing controversy. It is well accepted that these high risk men have a great need for clear guidance on early detection testing. PHEN has taken steps to address this need.

PHEN’s “Consensus Statement on PSA Testing for African American Men for the Early Detection of Prostate Cancer” was presented at its “Annual African American Prostate Cancer Disparity Summit” on September 18th, 2013. This consensus statement is based on the “expert opinion” of the twenty three (23) prostate cancer medical experts who are signatories on it. Using this consensus statement PHEN has now published “Guidance on Early Detection Testing for Prostate Cancer for High-Risk Men” that can be clearly understood by laymen. PHEN’s Consensus Statement and Guidance targets African American and other high-risk men. However, PHEN was not the first organization to recognize the need, and take steps, to separate prostate cancer early detection guidance for average-risk and high-risk men.

The American Urological Association (AUA) released its updated early detection guidelines on May 3, 2013 with this statement: “It is important to note that the guideline statements listed in this document target men at average risk , defined as men without risk factors such as family history of prostate cancer in multiple generations and/ or family history of early onset below the age of 55 years, or African American.”

It is important to note that both the AUA and PHEN saw the need to separate their early detection guidance for the exact same reason; a lack of scientific evidence from the PSA screening trials for African American and other high-risk men. The AUA however, stopped short of providing any direct guidance for high-risk men. PHEN, on the other hand relied upon expert opinion to formulate its guidance; the only option available in the absence of scientific evidence. It is only responsible and humane to provide clear and direct guidance to the men most likely to be diagnosed with and die from prostate cancer. A failure to do so I consider gross negligence.

Widespread adoption of separate guidance for high-risk and average-risk men for prostate cancer early detection testing is clearly needed. In addition, this step will help end the ongoing controversy that currently engulfs us all. Towards these objectives I call upon the AUA, National Comprehensive Cancer Network, U. S. Preventive Services Task Force, American Cancer Society, State Cancer Control Commissions, and Prostate Cancer Patient Education and Advocacy Organizations to embrace PHEN’s Consensus Statement for the Early Detection of Prostate Cancer for African American and other High Risk Men.

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