Hello friends, i'm IM PCP. I'm a few years out of residency.

I feel like the AUA guidelines leave a lot to be desired. Research (10.1056/NEJMoa2406050) is showing how useful mp-MRI of prostate is for risk stratifying and being more selective in prostate biopsies. It feels like this is something primary care should be doing more of - being selective and only referring certain patients for prostate biopsy - not all PSA elevations. I think this disagrees with the guidelines that advocate all 4+ should go to urology - is this really correct with how useful MRI is now?

PSA also varies by age. I don't like how vague the guidelines are but I am assuming that's because of limited evidence:

Most studies identifying age-varying thresholds specify threshold values of 2.5 ng/mL for people in their 40s, 3.5 ng/mL for people in their 50s, 4.5 ng/mL for people in their 60s, and 6.5 ng/mL for people in their 70s.

I met a urologist who recommended doing a one time test at ages 40 and 45 and ensuring PSA <2.5, too.…