New AUA guidelines only add confusion to the debate (Catalona)

The new guidelines do not say Don't Screen. They say to only that screening a man in this age group should include consideration of high risk men only and after consulting them of the issues involved.

Bill Catalona is one of the proud fathers of the PSA test. He has always spoken out about extensive use of it. But the actual creator of the test. Dr. Stephen Albin steadfastly wishes he never created the test.

The creator of the PSA test has said that when Dr. Catalona championed screening using PSA, he totally changing his own intended use of the test as a diagnostic tool.

Something to think about.

Tony

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Stacy Loeb May 9, 2013 at 2:54 pm Reply


My main concern with the guidelines relates to the age to begin screening:
1) There is level 1 evidence that screening beginning at age 50 reduces metastases and saves lives from the Goteborg population-based randomized trial. Screening in younger men with a shorter screening interval (2y vs 4y) resulted in a greater survival benefit than in the rest of the ERSPC.
2) There is also very strong evidence-- albeit not from a randomized trial-- to support a baseline PSA test in the 40's. The AUA guidelines do allow for earlier screening among men who are "high risk" (on the basis of family history or race). Our group reported in 2006 that baseline PSA at a young age is actually a stronger predictor of prostate cancer than race or family history (PMID: 16442597). The use of baseline PSA for risk stratification has been validated in many populations from around the world, including the recent study by Vickers et al. showing that it predicts later metastasis and disease-specific mortality (PMID 23596126). How can we determine who is really "high risk" without a PSA prior to age 55?"

exactly, there are bonafide experts on both sides, so how come the experts who do not agree with these news guidelines, like Samadi, Catalona (and more to come) get labeled as self serving in their opinions.

When I read your initial posts on the new guidelines I selfishly looked at them as a 40 year old and thought my group was getting completely screwed. I am starting to see more and more experts explain exactly why I was right and why that age group is getting screwed.

I already expressed my disappointment with the AUA new guidelines for the detection of PCa. It is confusing the issue and I said so before. We all are allowed our opinions...

The history of the development and invention of the test is different than reported here. A more accurate account follows:

The discovery of prostate-specific antigen (PSA) is beset with controversy; as PSA is present in prostatic tissue and semen, it was independently discovered and given different names, thus adding to the controversy.

Flocks was the first to experiment with antigens in the prostate and 10 years later Ablin reported the presence of precipitation antigens in the prostate.[

In 1971, Hara characterized a unique protein in the semen fluid, gamma-seminoprotein. Li and Beling, in 1973, isolated a protein, E1, from human semen in an attempt to find a novel method to achieve fertility control.

In 1978, Sensabaugh identified semen-specific protein p30, but proved that it was similar to E1 protein, and that prostate was the source.

In 1979, Wang purified a tissue-specific antigen from the prostate (named it prostate-specific antigen).

PSA was first measured quantitatively in the blood by Papsidero in 1980,and Stamey carried out the initial work on the clinical use of PSA as a marker of prostate cancer.

The FDA approved the first PSA test in 1986 for monitoring patients already diagnosed with prostate cancer.

In the April 25, 1991 issue of the New England Journal of Medicine established that the PSA test, combined with rectal examination or ultrasonography, provides an effective method of detecting prostate cancer.

In August 1994, the FDA approved the Hybritech Tandem® brand PSA test for use with rectal examination to aid detection of prostate cancer in men age 50 and older.

The inventors of the test at Roswell Park Cancer Institute in Buffalo, New York were:
Drs. T. Ming Chu, Ming Chang Wang and Lawrence C. Papsidero and colleagues.

Sources:
www.ncbi.nlm.nih.gov/pubmed/?term=Rao+AR+and+PSA

en.wikipedia.org/wiki/Prostate-specific_antigen

RalphV

DavidG, Tony, and RalphV,
Let's open this up to the "average Joe"--me! Thanks David for initiating this informed thread.
I urge all members and "lurkers" to read this article which you have highlighted. The newly published AUA testing guidelines appear to be a "public relations disaster" which led to erroneous/misleading articles in the mass media; this will be to the detriment of men's health.
At age 71, I just reviewed my annual physical report and counted 27 tests of my blood and urine. It doesn't seem reasonable to deny a man 40 years of age a baseline test and if it's over 1 to watch it in the future. Surprisingly, like the USPSTF recommendation, the AUA guidelines seem to stress the "harms" of psa testing and not the benefits.
At least the AUA took the task force to "task" and basically said that due to "contamination" the US study should not be relied upon; however, they then used the European figures of 1 man saved out of every 1,000 screened. I guess that I don't follow the number needed to screen (293) and the number needed to treat (12) to save 1 life over a 14 year period. My math is terrible so could someone help me out.
I am highly skeptical of entities that utilize terminology like "science, facts, evidence" to justify SWAG estimates or recommendations..Is 1 out of 1,000 a "fact"??
Bill

ralf: thanks for posting what you did. I always count on you to be the informed voice of reason in these matters. I find you to have a very experienced but balanced view, and one that is clearly in the best interest of the PC patient. Appreciate that in you.

david in sc