The new draft recommendation on PSA screening from the U.S. Preventive Services Task Force (USPSTF), which improves the previous D rating for all men to a C rating for those ages 55 to 69 years, has been met with guarded approval by three of the key national organizations representing urologists.
Bob GattyThe new draft recommendation on PSA screening from the U.S. Preventive Services Task Force (USPSTF), which improves the previous D rating for all men to a C rating for those ages 55 to 69 years, has been met with guarded approval by three of the key national organizations representing urologists.
The AUA, LUGPA, and the American Association of Clinical Urologists (AACU) joined several other advocacy groups in responding to the statement; see bit.ly/USPSTFstatement.
The new recommendation, which maintains a D rating for men ages 70 years and older, was posted April 11 at www.screeningforprostatecancer.org with comments invited until May 8.
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“Through its systematic review of the evidence, the task force determined that the potential benefits and harms of prostate-specific antigen (PSA)-based screening are closely balanced in men ages 55 to 69, and that the decision about whether to be screened should be an individual one,” the USPSTF said in a news release. “Clinicians should talk to men ages 55 to 69 about the potential benefits and harms of screening. This is a C recommendation.”
For men ages 70 years and older, the USPSTF said, “The potential benefits of PSA-based screening do not outweigh the harms, and these men should not be screened for prostate cancer. This is a D recommendation.”
The draft recommendation applies to adult men who have not been previously diagnosed with prostate cancer and have no signs or symptoms of the disease. It also applies to men at average risk and men who are at increased risk, such as African American men and those with a family history of prostate cancer. The USPSTF also called for additional research on prostate cancer risk in African-American men and men with a family history of the disease.
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“Most urologists should be happy with the C rating for men 55 to 69,” AUA spokesman David F. Penson, MD, MPH, told Urology Times. “That is a major change for the task force and recognizes the need to balance risks and benefits of screening. It allows us to consult with patients and offer them screening if they want it.”
Dr. Penson said additional research is needed and welcomed the task force’s call for additional research on the potential benefits and harms of screening among men at higher risk of prostate cancer, such as African-American patients and those with a family history of the disease.
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The AUA commended the USPSTF for upgrading its recommendation for screening among men 55 to 69 years of age.
“The draft recommendations… are thoughtful and reasonable, and are in direct alignment with the AUA’s clinical practice guideline and guidelines from most other major physician groups,” said AUA President Richard K. Babayan, MD.
Regarding the D rating for older men, Dr. Babayan said, “We believe that selected older healthier men may garner a benefit from prostate cancer screening and should, therefore, talk to their doctors about the benefits and risks of prostate cancer screening.”
LUGPA President Neal Shore, MD, also welcomed the upgraded rating for men aged 55 to 69 years, but said the organization remains concerned about the task force’s continued use of “arbitrary age cutoffs” in its recommendations, both for younger and older men.
“LUGPA believes that the USPSTF did not adequately address the needs of these high-risk groups in neither younger men nor for healthy male populations over 70, both groups that could benefit from early detection of high-risk prostate cancer,” Dr. Shore said.
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LUGPA and the AACU each urged Congress to approve legislation to reform the USPSTF, HR 539, which would require the task force to formally consult with stakeholders, including specialists and patient groups, in the development of new recommendations.
The AUA was a bit more muted on that topic. Dr. Babayan thanked the USPSTF “for implementing strategies to solicit feedback from the community on its research plan, and for engaging urologists to review the evidence report upon which these draft recommendations were based.”
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AACU President Charles A. McWilliams, MD, said the USPSTF’s recommendation incorporates many of the AACU’s longstanding positions and past comments that call for an individualized approach to screening based on an informed discussion between patients and doctors.
He said the task force’s call for additional research on prostate cancer in African-American men “reinforces the need for individualized evaluation of the appropriateness of PSA-based screening based on factors specific to each patient.”
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“These factors, of course, include age, and the AACU opposes the task force’s blanket recommendation against screening for men over the age of 70,” said Dr. McWilliams. “With life expectancy growing two-and-a-half years every decade, we believe select men over the age of 70 may benefit from prostate cancer screening.”
The AACU also cautioned against associating PSA-based screening with potential harms of overtreatment, which USPSTF emphasized in its draft recommendations.
“Continuing to tie potential complications with the awareness-raising test does not match up with the task force’s own acknowledgement that ‘[active] surveillance has become a more common treatment choice for men with lower risk prostate cancer over the past several years,’ ” he said.
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