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PHEN Guidance on Early Detection Testing for Prostate Cancer
African American men suffer the highest prostate cancer incidence and mortality rates among men of all racial and ethnic backgrounds in the United States. This racial disparity is the largest for any major cancer and all African American men are deemed to be at high - risk for prostate cancer. While the African American prostate cancer mortality rate is 2.5 times greater than for men of other ethnic and racial groups, the mortality rate declined by 40% from 1992 to 2010 according to data published by the National Cancer Institute. Most studies attribute much of this decline to an earlier detection of the disease since the widespread use of the Prostate Specific Antigen (PSA) test.
There is ongoing debate and controversy surrounding the use of the PSA test. The "PHEN Consensus Statement on PSA Testing for African American Men for the Early Detection of Prostate Cancer" was published on September 18, 2013. This statement is the basis for PHEN's guidance as outlined here.
A). Baseline PSA testing for African Americans and other men deemed to be at high - risk for prostate cancer is suggested beginning at age 40 for predicting their future risk of prostate cancer.
A baseline PSA in the 40s has value for risk stratification. Men in this age group should discuss the benefits and risk of PSA testing with their physicians as part of a shared decision-making process. PSA testing should be a consideration for men with a life expectancy of more than ten (10) years.
B). PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection.
The PSA test is an imperfect predictor of current risk and additional variables such as digital rectal examination (DRE), prostate volume, family history, ethnicity, risk prediction models, and new tools, can help to better risk stratify men.
C). A prostate cancer diagnosis must be uncoupled from prostate cancer intervention.
Although early detection is essential to diagnose high-risk cases within the window of curability, many men with low-risk prostate cancer do not need immediate aggressive treatment. Men should consult with their physician(s) about their treatment options and caution should be exercised to prevent over-treatment. Active surveillance protocols have been developed and have been shown to be a reasonable and safe option for many men with low-volume, low-risk prostate cancer. Men diagnosed with the disease should discuss this option with their physician(s).
Note: African-American men, men with a family history of prostate cancer, and Vietnam veterans exposed to agent orange are deemed to be at high-risk for prostate cancer.