AUA, other groups criticize new PSA screening recommendations

October 20, 2011

The AUA said the U.S. Preventive Services Task Force is "doing a great disservice" to patients with its draft recommendations regarding the PSA test.

The AUA said the U.S. Preventive Services Task Force is "doing a great disservice" to patients with its draft recommendations regarding the PSA test.

The AUA was joined by a multitude of professional and patient advocacy groups that publicly took issue with the new USPSTF statement, which recommends against routine PSA-based screening because it results in little or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.

"AUA applauds the U.S. Preventive Services Task Force for its interest in reviewing the use of the PSA test," said AUA President Sushil I. Lacy, MD. "However, we are concerned that the task force’s recommendations will ultimately do more harm than good to the many men at risk for prostate cancer, both here in the United States and around the world. AUA’s current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, or risk assessment and monitoring of prostate cancer patients.

"Not all prostate cancers require active treatment and not all prostate cancers are life threatening. The decision to proceed to active treatment is one that men should discuss in detail with their urologists to determine whether active treatment is necessary, or whether surveillance may be an option for their prostate cancer.

"AUA is currently preparing a new clinical guideline on this topic," Dr. Lacy said, "and has convened a panel of experts to review not only the use of the PSA test, but also early detection of prostate cancer overall, taking into account the new tests and diagnostics that are becoming available. Until there is a better widespread test for this potentially devastating disease, the USPSTF is doing a great disservice to the men worldwide who may benefit from the PSA test."

The Prostate Cancer Foundation issued its own analysis of the recommendations, saying it supports continued routine PSA screening of informed patients until new AUA guidelines on PSA screening are issued, supports a patient’s choice to have a PSA test, and strongly recommends intensified National Cancer Institute focus and research investment in better early detection tests of lethal prostate cancers.

"The USPSTF has heightened awareness with new data of the issue of severe complications and patient suffering from the overdiagnosis and overtreatment of indolent prostate cancers," the foundation said in a statement.

"The USPSTF’s position provides a teachable and actionable moment for the medical community to improve targeting of PSA screening in patients, reduce over-testing and improve processes of patient education on the risks of overtreatment from PSA screening."

Prostate cancer patient advocacy group ZERO (The Project to End Prostate Cancer) decried the recommendations, stating that insurers would be unlikely to cover the test in light of the recommendations.

"Today’s decision of no confidence on the PSA test by the U.S. government condemns tens of thousands of men to die this year and every year going forward if families are to believe the out-of-date evidence presented by the USPSTF," said Skip Lockwood, CEO of ZERO. "A decision on how best to test and treat for prostate cancer must be made between a man and his doctor. This decision is coming from a panel that doesn’t even include a urologist or medical oncologist."

The task force is accepting comments on the recommendations through Nov. 8. We also encourage readers to comment on the new recommendations by completing the "POST A COMMENT" fields below.

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