Testifying at the hearing on behalf of the AUA, urologist John H. Lynch, MD, of MedStar Georgetown University Hospital, Washington, said there is a “disconnect” between practicing physicians and the Task Force caused by its composition, which includes primary care physicians but not specialists.
“While the USPSTF is composed of independent, national experts in prevention and evidence-based medicine, representation by urology or other medical specialties is noticeably absent when recommendations or research plans are under review,” he said. “I understand that every specialty provider cannot be represented full time on the Task Force, but having a specialty voice for individual recommendations can improve the outreach and review process.
“It is a disservice to patients to issue recommendations on the primary method used to diagnose prostate cancer or other conditions without consulting with those physicians who work with patients every day,” Dr. Lynch added.
Asked by Blackburn, a committee member, if the USPSTF sought input from the AUA or clinical oncologists regarding the PSA recommendation, Dr. Bibbins-Domingo said she could not be certain. However, she added, “We routinely engage in the specialty societies that have expertise in these topics, including to get feedback.”
In his testimony, Dr. Lynch outlined the reasons why urologists believe the 2012 recommendation was wrong, noting that he is a prostate cancer survivor and that “early detection saved my life, which is why this hearing is so important.”
“I, and many other urologists, strongly disagree with the Task Force’s assessment,” said Dr. Lynch. “Rather than issuing a blanket recommendation against screening, it would be better to ‘screen smarter’ by testing most men at individualized intervals (not every year) and adding additional focus to how we screen men at higher risk for disease. These decisions are best made between the physician and patient, taking into consideration their individual risk factors and family history.”
In testimony submitted to the subcommittee, Neal D. Shore, MD, president of LUGPA, and Deepak A. Kapoor, MD, chairman of health policy, went into great detail regarding use of the PSA and other screening methodologies for prostate cancer.
As a result of the 2012 recommendation, they said, “Many fewer men are being screened for prostate cancer; data shows that those being diagnosed with prostate cancer are being found with later stage, more aggressive disease. The cure rate for these patients is much lower, potentially leading to unnecessary deaths from prostate cancer.”