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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.
The "PHEN Consensus Statement on PSA Testing for African American Men for the Early Detection of Prostate Cancer" was published on September 18, 2013 and 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.
The PSA test is not a perfect predictor of current prostate cancer risk. Additional variables such as digital rectal examination (DRE), prostate volume, family history, ethnicity, biomarkers and imaging can help to better risk stratify men.
C). A prostate cancer diagnosis must be uncoupled from prostate cancer treatment.
Early detection is essential to diagnose high-risk prostate cancer within the window of curability, many men diagnosed 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 unnecessary 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. African American men should discuss active surveillance as an option with their physician and have a biomarker test performed to confirm if active surveillance is the right option.
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.