Speak Out: What's your reaction to the AUA best practice statement calling for baseline PSA testing to start at age 40?

December 1, 2009

Urologists offer opinions about the new guideline for baseline PSA testing.

It's so cheap; why wouldn't we do it earlier? They may push mammograms back because radiating breasts for 30, 40, 50 years can have secondary effects and is expensive. But PSA is a cheap blood test with no side effects. Why wouldn't we start earlier for our baseline?

If you save someone's life at 45, you give them 30 years, compared to diagnosing someone at 75 or 80. Younger guys are the ones we want to find. The chain of events you may set in motion are relatively inconsequential compared to the risks that come with waiting."

"It's [baseline testing at age 40] very controversial. I'm not sure it's a great idea because it can create a lot of anxiety that probably is unnecessary.

I don't object to the baseline concept, but PSA gets a lot of bad press and this could backfire. Patients tell me they've read PSA testing is worthless. I tell them it's valuable, but it needs to be interpreted.

With the controversy, I'm afraid the new guideline makes us look rather self-serving."

Jeffrey W. Zipkin, MD
Cincinnati

"I have a large African-American male patient population for whom it's always been recommended that PSA testing start at age 40. That's a given.

But we've been doing this for 20 to 25 years now, so we are beginning to identify more men with a known family history of prostate cancer. So if I was 20 years old, 20 years ago, I may have a first-degree male relative who was, in fact, diagnosed with prostate cancer already.

Some of this may be because a whole generation has passed and we know which men may be at higher risk at an earlier age. This may also help make men more aware of their own health issues."

Gail Reede Jones, MD
Little Rock, AR

"I'm glad to see AUA put more judgment in the hands of urologists rather than setting minimum threshold PSA values where biopsies are recommended.

I'm concerned, however, that we may create a whole new population of anxious men in their 40s who will interpret their PSAs as meaning they're going to get prostate cancer within the next 5 to 15 years.

The guideline will be good for men with low PSA values and negative family history who can come back in 10 years, as opposed to the man who has a borderline value. In the case of the latter, how often do you bring him back? How do you calm his fears?

The big question remains: Are we clinically going to make a difference with what we do? This guideline may raise more questions than it answers."

Timothy M. Roddy, MD
Mountlake Terrace, WA