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Dr. Lin's Quest beyond Medication and Surgery                  

    AUA 2013 Guidelines on Prostate Cancer Screening as of May 3, 2013

  • based on a rigorous systematic literature review by a multidisciplinary team, involving medical and radiation oncologists,
    general internists, epidemiologists, and urologists to generate evidence-based recommendation;

  • Asymptomatic average-risk men are those with no family history of prostate-cancer, non-blacks, and no Agent Orange exposure;

  • Conversely, other men are high-risk, namely, positive FH of prostate-cancer, black population, and exposure to Agent Orange;

  • Prime age group for screening: 55-69 (for easy remembrance, adopt 55-70), offering more benefit than harm from prostate-
    cancer / PSA screening;

  • Do Not Screen in These Groups:
    1. <40 years;
    2. 40 – 54 years with average risks (for easy remembrance, adopt 40-55);
    3. > 70 years with average risks;
    4. life expectancy <10-15 years.

  • Still Do Screen in These Groups:   <55 years and >70 years with high risks as stated above.

  • AUA 2013 Guidelines supersede and replace the 2009 AUA Best-Practice document recommending starting screen at age 40,
    which was based on opinion and clinical evidence.

    But, I do recommend repeating PSA test timely in men with abnormal findings such as local hardness, nodule, or uneven consistency
    in prostate, regardless of age and, even, health.

    I do alkaline phosphatase timely in men with rising PSA after definite Rx for prostate cancer so to decide if bone scan is needed or not
    because the accumulated studies have shown that bone scan has low, insignificant yield of positive finding for metastasis if alkaline
    phosphatase is normal or not fast rising.

    What are the current widely diversifying disputes among different organizations?

    The American Academy of Family Physicians (AAFP) and the United States Preventive Services Task Force (USPSTF) recommend
    against screening in all cases.

    The National Comprehensive Cancer Network (NCCN) recommends screening beginning at age 40 years.

  Why do the recommendations from different organizations so widely vary?

    According to Dr. Pension, the lecturer of a State-of the Art Lecture titled Evidence -based vs.Concensus-based Guidelines on PSA: What
    are the Differences and Why? One vs. the Other? in AUA 2014 Convention in May 2014 in Orlando, Florida, he pointed out the wide
    differences between the approach with concensus-based opinions or best practice panels and the one with evidence-based.

    Dr. Pension stated, "Guidelines that are evidence based are created using a relatively unbiased and transparent process of
    systemically reviewing and appraising the highest quality of clinical research findings to make a final decision about how to deliver
    optimal care to patients."

    As already evidenced in the clinical scenes of PSA since its discovery in 1970, much ups and downs of praising its merits and
    disgracing its misuse have been widely revealed and confirmed over the past 45 years.

    As a result, Dr. Ablin, who discovered PSA in 1970, outcried in public saying,I never dreamt that my discovery 4 decades ago would
    lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of
    PSA screening. Doing so would save billions of dollars and rescue millions of men from unnecessary debilitating treatment.”

    The pressure of professional scrutiny, political correctness, and commercialism has brewed the drastic adjustment and change
    among various organizations notably over the past 6 years to meet the need to strengthen their professional and political position as
    envisioned in their own agenda.  

    So, the change and dispute in PSA best possible usage will not stop here, but surely continue to adjust and evolve around the wheel
    and along the course of ongoing collection and analysis of updated clinical experience.

PSA / its Use, Prostate
Cancer / its Care...  
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