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Behind the Headlines-04

Us TOO FLORENCE - BEHIND THE HEADLINES-4
BY BOB HORNEY - PROSTATE CANCER SURVIVOR - Us TOO CHAPTER LEADER
(Published December 11, 2013, The Siuslaw News)

Us TOO Florence, thought it would happen - sooner or later - and we're delighted it happened sooner and in triplicate, too. Although not going as far we would have liked, the European Association of Urology, the 2013 Prostate Cancer World Congress and the Large Urology Group Practice Association (LUGPA) all stand united in recommending a baseline PSA blood test for men in their 40s.
This much needed and appreciated push-back is in direct response to the U.S. Preventive Services Task Force (USPSTF); American Academy of Family Physicians (AAFP); American College of Physicians (ACP); American Cancer Society (ACS) and the American Urological Association (AUA), that have either withdrawn total support for PSA testing or, at a minimum, severely limited its recommended use. The guidelines of these groups go from no screening at all to screening starting at ages 50 or 55 and stopping at age 69.
Following are the guidelines put forth by the 3 first-mentioned groups.
European Association of Urology:
The European Association of Urology recommends obtaining a baseline prostate-specific antigen (PSA) level at 40-45 years of age and adapting follow-up intervals according to that baseline PSA.
2013 Prostate Cancer World Congress:
Baseline PSA testing for men in their 40s is useful for predicting the future risk of prostate cancer.
Large Urology Group Practice Association (LUGPA):
A baseline serum PSA level should be obtained from men in their 40s who have made an informed decision to pursue early detection of prostate cancer.
Intervals for an individual's prostate cancer screening should be adapted to: baseline PSA, prostate cancer risk factors (including African-American heritage and a family history of prostate cancer), and the potentially short preclinical timeline of aggressive cancers.
Noting the lack of agreement for PSA testing among the USPSTF, AAFP, ACP, ACS and AUA, Deepak A. Kapoor, MD, president of LUGPA made the following statement: "Unfortunately, these conflicting statements have resulted in confusion amongst both our patients and fellow physicians. It should be made clear that a PSA test is simply a tool that facilitates informed decision making; it is neither a commitment to have a biopsy nor an obligation to receive treatment should prostate cancer be detected."
In his book, Guide to Surviving Prostate Cancer, Patrick Walsh, MD, Distinguished Service Professor of Urology at Johns Hopkins Medical Institutions, lists three reasons men should get a baseline PSA in their 40s: "First, many men whose prostate cancers go undetected before they're in their fifties eventually die of the disease. Most of these men have no particular reason to worry about prostate cancer - they don't have a strong family history, and they're not African American. But it is very likely that most of the men between ages fifty and sixty-four who die of prostate cancer could have been saved if the disease had been caught when they were in their forties. Second, younger men are more likely than older men to have curable disease and to have fewer side effects from treatment. And finally, PSA is a better, more specific test in younger men who - unlike older men - don't tend to have BPH (benign prostatic hyperplasia), which can falsely raise the PSA level."
Here is Dr. Walsh's personal recommendation: "Getting your first PSA test and digital rectal exam at age forty, when you are unlikely to have BPH, will give you a valuable baseline for every other PSA measurement you'll ever need; the results of these baseline tests have been shown to predict a man's risk of being diagnosed with prostate cancer over the next twenty-five years."
Us TOO Florence totally supports Dr. Walsh's recommendation of age 40 - just plain and simple - age 40. Hopefully, the above three groups will eventually revise their recommendations to those of Dr. Walsh and Us TOO Florence.


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