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NCCN view: J. Kellogg Parsons, MD, MHS. In 5 minutes, Dr. Parsons discussed 3 algorithms that are published in the NCCN guidelines: 1) whether to screen. 2) Interpretation of PSA results and whether to biopsy. 3) Interpretation of biopsy results and whether to treat.
In men between age 45-75 with a PSA >3, the NCCN recommends biopsy or adjunctive tests. If there is no cancer detected on biopsy, the NCCN recommends MRI or reflex testing.
In 2017, the NCCN will update its recommendations to include: in patients >75 yrs, PSA threshold increased to >4. They will make recommendations on family history and genetic testing. They will discuss new biomarkers. They will likely recommend consideration of upfront mpMRI (prior to biopsy).
AUA view: Herbert B. Carter, MD. Johns Hopkins University. Dr. Carter presented 1 slide summarizing the AUA guidelines. He emphasized the importance of individualized decision making. He stated that biennial testing may reduce harms of PSA testing. The target group is age 55-69yrs with caveats for FH, race, and healthy older men.
Asia view: Kazuto Ito, MD. Gunma University. Dr. Ito presented 1 slide. He reminded us of the relatively low incidence of PCa in Asian countries, but pointed out that the incidence is greatly increasing. The reasons for this (increased screening/testing?) was not elaborated. He recommends to check baseline PSA in late 40s or early 50s and follows age-specific PSA thresholds for biopsy. Age<65y: 3.0ng/ml. Age 65-69: 3.5, Age>70: 4. He recommends rescreening at differing intervals dependent on PSA levels: Every year if PSA >1.1, every 3 years if PSA <1. He recommends to stop screening based on G8 geriatric tool especially for men >80yrs.
Overall, the four presenters had very thoughtful and similar approaches, which should reassure our patients.
Presented by: Nicolas Mottet, MD-PhD University Hospital north and J. Kellogg Parsons, MD, MHS UC San Diego Moores Cancer Center
Contributed by: Jed Ferguson, MD/PhD and Ashish Kamat, MD. MD Anderson Cancer Center, Department of Urology.
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA