An expert panel convened by AUA has published (2013) guidelines for prostate cancer screening using PSA-

Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years (Recommendation; Evidence Strength Grade C). In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.

Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. (Recommendation; Evidence Strength Grade C). For men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualised.

Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences (Standard; Evidence Strength Grade B). The greatest benefit of screening appears to be in men ages 55 to 69 years.

Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives (Option; Evidence Strength Grade C). Additionally, intervals for rescreening can be individualised by a baseline PSA level.

Guideline Statement 5: The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy. (Recommendation; Evidence Strength Grade C)

Results published from the ART study in Europe Urol (2013) show that PSA progression is significantly reduced in patients with PSA failure after radical treatment compared to placebo. 294 patients where studied over a 2 year period.

In an article by respected experts including Walsh, Epstein and Partin published in BJUI (2013) a prognostic index based on Gleason score was proposed. This should simplify the patient interpretation of risk of prostate cancer recurrence following radical prostatectomy. The prognostic index would be reported 1-5; Gleason score ≤6 (prognostic grade group I); Gleason score 3+4=7 (prognostic grade group II); Gleason score 4+3=7 (prognostic grade group III); Gleason score 4+4=8 (prognostic grade group (IV); and Gleason score 9–10 (prognostic grade group (V).

In an article by Gruenwald et al published in Ther Adv Urol (2013) the authors report a novel treatment for patients with erectile dysfunction.

In an initial study of 15 patients, one month after LI-ESWT, the erectile function in all the men improved. An increase by more than five points in the International Index of Erectile Function – Erectile Function (IIEF-EF) domain score was noted in 14 men, and by more than 10 points in 7 men. Five men did not respond to LI-ESWT. Overall, the average increase in the IIEF-EF domain scores was 7.4 points (13.5–20.9, p = 0.001). Furthermore, erectile function and penile blood flow were measured using nocturnal penile tumescence (NPT) and venous occlusion plethysmography of the penis, respectively. LI-ESWT improved all NPT parameters, especially in the 15 men who responded to LI-ESWT, where significant increases in the duration of the erections and penile rigidity were recorded. Penile blood flow also improved significantly and a strong correlation was found between the increase in the IIEF-EF domain scores and the improvement in penile blood flow at the 1-month follow-up examination. At the 6-month follow-up visit, 10 men reported that they still had spontaneous erections that were sufficient for penetration and did not require PDE5i support.

In view of these very successful preliminary results, the effect of LI-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Gruenwald et al (2012)]. The average initial IIEF-EF domain score of the 29 men who were recruited for this second study was 8.8 ± 1. All 29 men had not responded to oral PDE5i therapy, and had multiple cardiovascular risk factors (23), cardiovascular disease (11), and diabetes mellitus (14). The specific aim of this second study was to investigate the ability of LI-ESWT to convert nonresponders to PDE5i therapy to PDE5i responders, so that they were able to achieve vaginal penetration with oral PDE5i therapy. The results were comparable to the first study. Three months after the completion of the LI-ESWT protocol, the IIEF-EF domain scores improved by at least five points in 22 men (76%) and the mean IIEF-EF domain score increased by 10 points (to 18.8 ± 1, p < 0.0001). At the end of the study, eight men (28%) achieved normal erections (IIEF-EF domain score greater than 25) and 21 of the 29 men were able to achieve vaginal penetration with oral PDE5i therapy. Overall, 21 men (72%) were converted to PDE5i responders. Cavernosal blood flow and penile endothelial function, as measured again by venous occlusion plethysmography of the penis (flow-mediated dilatation techniques [FMDs]), were both found to be significantly improved (p = 0.0001) in the men who responded to LI-ESWT.

These preliminary results are very interesting, but require confirmation in larger studies.

In an article by Bul et al published in Eur Urol (2013) the authors conclude that active surveillance is a safe and effective strategy to reduce overtreatment of men with low risk prostate cancer. They studied 2494 men with a PSA <10, Gleason score<7, PSAD<0.2 and less than 3 cores positive. Rebiopsies were scheduled at 1, 4 and 7 years. The treatment was deemed a failure if the PSADT was<3 years or if the was progression on repeat biopsy. At a median follow up of 1.6 years only 28% of patients had progressed.