The American Urological Association (AUA) stands as the leading urologic association, offering invaluable support to the global urologic community and its 23,000 members. Their mission is to advance the highest standards of urological clinical care through education, research, and the development of healthcare policies.

AUA’s Clinical Practice Guidelines provide evidence-based guidance with a clear scope and purpose, offering the urology community peer-reviewed treatment recommendations and research updates.

In this edition of our Guidelines Timelines Series, we will be reviewing the Early Detection of Prostate Cancer from 2013 versus the current iteration from 2023 in honor of National Prostate Cancer Awareness Month 2024. While we won’t cover everything in the guidelines, we will cover some of the highlights and key takeaways.

AUA Prostate Cancer Guidelines (2023 and 2013)

Major Changes & Key Takeaways: 2023 vs 2018

The 2023 AUA guidelines for the early detection of prostate cancer have several key updates compared to the 2013 guidelines:

  • Shared Decision-Making: The 2023 guidelines emphasize shared decision-making (SDM) for all patients considering prostate cancer screening, regardless of age. This approach ensures that screening decisions are based on individual values and preferences.  While the 2013 guideline emphasized shared decision-making primarily for men aged 55-69.

  • PSA Screening Age: The 2023 guidelines recommend offering PSA testing starting at age 45 for those at average risk, whereas the 2013 guidelines advised against routine screening for men aged 40-54. Screening was more focused on men aged 55-69, with shared decision-making emphasized for this group.

  • Risk-Based Screening: For individuals at increased risk (e.g., those with Black ancestry, germline mutations, or a strong family history of prostate cancer), the 2023 guidelines suggest starting screening between ages 40 to 45. The 2013 Guideline did not specifically highlight screening recommendations based on risk factors like family history or genetic predispositions.

  • Screening Frequency: The 2023 guidelines recommend regular screening every 2 to 4 years for men aged 50 to 69.

  • Digital rectal exam (DRE): DRE is considered optional as a complementary screening modality to PSA testing in the 2023 guidelines.

  • Follow-Up for Elevated PSA: The 2023 guidelines advise repeating the PSA test before proceeding to secondary biomarkers, imaging, or biopsy if a newly elevated PSA is detected. These updates reflect a more personalized approach to prostate cancer screening, aiming to balance the benefits and risks more effectively. The 2013 Guidelines recommend repeating PSA tests before proceeding to secondary biomarkers, imaging, or biopsy if PSA levels are newly elevated.

Thank you for following along with our Guidelines Timelines Series on AUA’s Early Detection of Prostate Cancer.  We appreciate your interest and encourage you to stay tuned for future installments of our Guidelines Timelines. Sign up for alerts and stay informed on the latest published guidelines and future installments of our Guidelines Timelines.

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