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recommendation of the USPSTF and suggests these tests be offered at age 50 for men who have a life expectancy of greater than 10 years and at age 45 for men at increased risk for prostate cancer (African-American males and those with considerable family histories). The American Urological Association (AUA) has recently revised its recommendation for screening to begin at age 40, continue routinely thereafter for these higher-risk populations and cease during a man's early 70s. The AUA believes early detection of and risk assessment for prostate cancer should be offered to asymptomatic men with the above age guidelines who have a life expectancy of at least 10 years. While these detection guidelines are well-supported by many practicing urologists, it is openly acknowledged that the PSA test has its limitations. Currently, the PSA test detects both cancerous and noncancerous abnormalities of the prostate gland, and researchers are actively working to identify new biomarkers (e.g. genetic tests) and imaging studies that could help distinguish between benign and malignant prostate gland conditions. Recognizing that a single PSA value is not always reliable, alternative PSA measurements have been proposed and implemented by physicians in an attempt to more accurately determine individualized prostate cancer risk and minimize undue treatment. PSA velocity, or change in PSA level over a period of time, has become a popular topic of ongoing research and has been validated as a marker for prostate cancer aggres- siveness.4 Complexed PSA value provides better insight as to what fraction of one's total PSA is bound to serum protease inhibitors and has also proven to enhance prostate cancer detection in men.5 Additionally, as individuals have prostates of different sizes, PSA density has also been taken into recent consideration for prostate cancer diagnosis. As a measurement, PSA density is equal to serum PSA level divided by a man's transrectal ultrasound-determined prostate volume — which can help control for the large variation in the amount of PSA-producing benign tissue men have. Serum PSA levels also increase with a man's age, hence age adjustment is also important when deciding whether or not to biopsy an individual after screening. As doctors have gained knowledge about and familiarity with the benefits and drawbacks of the PSA test, we have become more effective in utilizing it as a screening tool. Prostate cancer typically does not cause symptoms until an advanced stage. Thus, until References 1. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Eng J Med, 2009. 360(13): 1320-8. 2. www.seer.cancer.gov/statfacts/html/prost.html 3. U.S. Preventative Services Task Force. Screening for prostate cancer: U.S. Preventative Services Task Force recommendation statement. Annals of Internal Medicine, 2008. 149(3): 185-91. 4. Loeb S, Southerland DE, D'Amico AV, et al. PSA velocity is associated with gleason score in radical prostatectomy specimen: marker for prostate cancer aggressiveness. Urology, 2008. 72(5): 1116-20. 5. Horninger W, Cheli CD, Babaian RJ, et al. Complexed prostate-specific antigen for early detection of prostate cancer in men with serum prostate-specific antigen levels of 2 to 4 nanograms per milliliter. Urology, 2002. 60(4 Suppl 1): 31-5. MDNEWS.COM s MD NEWS Central New York | 19 medical innovation establishes a more valuable means of prostate cancer screening, it is imperative that men do not overlook the benefits of early detection potentially offered by the PSA test. Most urologists advise that men who wish to be screened have both a PSA test and a DRE. However, the decision to proceed to a prostate biopsy should be based not only on the PSA and DRE results, but also should take into account multiple factors, including free and total PSA, a patient's age, PSA velocity, family history, ethnicity, prior biopsy history, and other illnesses the patient may have. Urologists also strongly support informed consent before screening is undertaken, as well as the option of active surveillance in lieu of immediate treatment for carefully selected patients with low-risk disease. During this "watchful waiting" period, patients can be monitored for signs of progres- sion via periodic PSA tests, DREs, and sometimes imaging or additional biopsies. If such tests indicate cancer growth, treatment will be recommended. The AUA, ACS and board-certified urologists warn against the recent published skepticism that surrounds the current methods of prostate cancer screening and urge individuals to personally assess with their physicians whether or not a PSA test is necessary. Simply discarding the PSA test based on the USPSTF recommendation could have potentially devastating consequences for many men and their loved ones. If this panel's recommendation is adopted, urologists fear government programs and private insurance companies may eventually deny coverage for PSA testing. Such actions could increase health care disparities and would lead to many men forgoing the possibility of early prostate cancer detection, thus risking the development of preventable aggressive and/or metastatic cancer. s