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    PSA screening: Be a resource for your patients, providers

    Adele M. Caruso, MSN, CRNPAdele M. Caruso, MSN, CRNP

    Urology Times Blogger Profile

    Ms. Caruso is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia.

     

    Often, the urology nurse practitioner or physician assistant receives an email from a colleague regarding that “PSA screening question.” Are you a good resource? What do you advise? In my first blog post for Urology Times, I will provide an overview of the PSA screening debate and discuss resources you can share with colleagues when patients raise questions about screening. 

    Related: AUA, others fight measure penalizing docs who order PSA

    PSA screening. In the past 2 decades, PSA-based prostate cancer detection became ingrained in urologic and primary care practices. This occurred despite the fact that PSA did not have the best characteristics for a screening assay. Recent studies, though not perfect, demonstrate that many men undergo unnecessary biopsies and that many low-risk tumors are identified, which results in a “cancer diagnosis” and the potential for overtreatment. In my practice, I make recommendations for screening or not for screening, according to the AUA and shared decision-making.

    AUA stance. Early Detection of Prostate Cancer: AUA Guideline have recommendations for men under the age of 40, men ages 40-54, men ages 50-55, and men age 70 years and older. Other considerations include a positive family history or African-American race. Again, prostate cancer screening and the decision to pursue a prostate needle biopsy should be individualized to the patient’s particular situation.

    Also see: Why urology residents should care about health policy

    U.S. Preventive Services Task Force recommendation and AUA response. In 2012, the United States Preventive Services Task Force (USPSTF) issued its own recommendation on screening, which was incongruent with current practice. The “D” grade given by the USPSTF suggested that there was no role for PSA screening. This is the subject of much debate. In November 2015, the USPSTF proposed a revised analytical framework for prostate cancer screening that was opened for public comment. The AUA leadership published thoughtful comments in response to this outline, which can be found here.

    Next: "I recommend reading what our patients and colleagues are reading."

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