The final recommendation on screening for prostate cancer issued May 8 by the U.S. Preventive Services Task Force (USPSTF), which gives a “C” grade for PSA testing in men 55-70 years of age, has been met with mixed reviews by prostate cancer-focused organizations, some of which continue to call for legislation to reform the task force itself.
While the AUA issued a statement commending the USPSTF on its recommendations and its process for developing them, LUGPA was sharply critical, expressing “grave concerns” about aspects of its ruling.
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Both groups, however, said legislation to reform the USPSTF process, the USPSTF Transparency and Accountability Act of 2017, should be enacted.
The AUA said the task force’s final recommendations “demonstrate the value of involving specialists, patients and the medical community in creating reasonable and thoughtful clinical guidance,” and thanked the USPSTF for soliciting community feedback, engaging urologists to review the evidence on which its recommendations were based, and considering comments from the prostate cancer community.
But it also commended Reps. Marsha Blackburn (R-TN), Bobby Rush (D-IL), and other lawmakers for encouraging the USPSTF to adopt a more transparent process and said their legislation, the USPSTF Transparency and Accountability Act, “is needed to ensure transparency and regular input in the process from interested stakeholders and specialists with appropriate expertise.”
However, LUGPA President Neal Shore, MD, a Myrtle Beach, SC urologist, said the USPSTF’s decision to finalize the draft recommendations released more than a year ago “is the byproduct of a process that is neither open nor transparent.”
“The USPSTF continues to be exempt from the Federal Advisory Committee Act; as such, it is not obliged to hold meetings in public, consider public comments, disclose its methodology, nor is there any recourse for those harmed by its decisions,” Dr. Shore said. The legislation, he contended, is needed to provide “common sense reforms that both preserve the advisory capacity of the USPSTF while simultaneously restoring basic oversights that apply to all advisory committees with similar authority.”
The USPSTF’s final recommendation states that men ages 55-69 years should make an individual decision about whether to get PSA-based screening for prostate cancer after discussing potential benefits and harms with their clinician, considering their specific clinical circumstances and incorporating their values in the decision—a “C” recommendation.
For men 70 years of age and older, the USPSTF continues to recommend against PSA-based screening—a “D” recommendation.
The task force said the final recommendation applies to all adult men who have no signs or symptoms of prostate cancer and who have never been diagnosed with the disease. It includes men at increased risk, such as African-American men and men with a family history of prostate cancer.
“For men who are more interested in the small potential benefit and willing to accept the potential harms, screening may be the right choice for them,” said task force Vice Chair Douglas K. Owens, MD, a general internist and associate director of the Center for Innovation to Implementation at the Veterans Affairs Palo Alto Health System. “Men who place more value on avoiding the potential harms may choose not to be screened.”
The AUA said it agreed with the USPSTF that African-American men and men with a family history of prostate cancer are at increased risk and should discuss with their physicians the benefits and risks of testing in order to make a shared, informed decision.
However, the AUA said that although it agrees that “a number of older men are not candidates for prostate cancer testing, we believe that select, older, healthier men may garner a benefit. We urge those men to talk with their doctors about whether prostate cancer testing is right for them.”
The AUA acknowledged that there is “limited evidence” regarding the benefits and risks of prostate cancer testing in men over 70 years of age, and that it supports additional research to “better inform recommendations for these individuals.”