Thanks to Kathy Meade again for the attached...
Testing at 40? It's about time. The AUA (American Urologic Association) has begun it's meetings in Chicago. Starting with new guidelines for prostate cancer screening. The following points from the attached article include:
Serum PSA predicts the response of prostate cancer to local therapy.
Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA level is ≤20.0 ng/mL.
CT or MRI scans may be considered for the staging of men with high-risk clinically localized prostate cancer when the PSA is >20.0 ng/mL or when locally advanced or when the Gleason score is ≥8.
Pelvic lymph node dissection for clinically localized prostate cancer may not be necessary if the PSA is <10.0 ng/mL and the Gleason score is ≤6.
Periodic PSA determinations should be offered to detect disease recurrence.
Serum PSA should decrease and remain at undetectable levels after radical prostatectomy.
Serum PSA should fall to a low level following radiation therapy, high intensity-focused ultrasound and cryotherapy and should not rise on successive occasions.
PSA nadir after androgen suppression therapy predicts mortality.
Bone scans are indicated for the detection of metastases following initial treatment for localized disease, but the PSA level that should prompt a bone scan is uncertain. Additional important prognostic information can be obtained by evaluation of PSA kinetics.
The kinetics of PSA rise after local therapy for prostate cancer can help distinguish between local and distant recurrence.
<Extract>There is emerging evidence from studies done in Sweden that a single PSA determination in your 40s helps determine your lifetime risk of developing prostate cancer. This is relatively new data and it will allow us to tailor our screenings strategies. It's clear from that data and from the Prostate Cancer Week Awareness campaign over the last two decades in the United States, and the two studies published in the NEJM — the PLCO and the European screening trial — that not everybody needs to be screened every year. So starting with a baseline PSA at 40 gives you some idea what your future risk is and how often you need to be screened.
http://www.hemonctoday.com/article.aspx?rid=39268
My own commentary: Logic has been telling me that mortality and prostate cancer is more predictable than has been found. If a man in his forties has high risk PCa, then what are his chances with the disease. I have spentthe last two and a half years finding virtually no studies that include 40 year old men. The recent releases of the screening contraversy continued that trend. My thought is that if we are studying 55 and up and there is little mortality, then where do we get 28,000 men a year dying from this disease in this country? My answer was that it's at least in part the younger group flying under the radar of studies. The irony of the day is that the US report that questions screening, will now lead to more of it. I am not surprised.
Tony