PSA screening: Be a resource for your patients, providers

Often, the urology nurse practitioner or physician assistant receives an email from a colleague regarding that “PSA screening question.” Are you a good resource? What do you advise? In my first blog post for Urology Times, I will provide an overview of the PSA screening debate and discuss resources you can share with colleagues when patients raise questions about screening. 

Related: AUA, others fight measure penalizing docs who order PSA

PSA screening. In the past 2 decades, PSA-based prostate cancer detection became ingrained in urologic and primary care practices. This occurred despite the fact that PSA did not have the best characteristics for a screening assay. Recent studies, though not perfect, demonstrate that many men undergo unnecessary biopsies and that many low-risk tumors are identified, which results in a “cancer diagnosis” and the potential for overtreatment. In my practice, I make recommendations for screening or not for screening, according to the AUA and shared decision-making.

AUA stance.Early Detection of Prostate Cancer: AUA Guideline have recommendations for men under the age of 40, men ages 40-54, men ages 50-55, and men age 70 years and older. Other considerations include a positive family history or African-American race. Again, prostate cancer screening and the decision to pursue a prostate needle biopsy should be individualized to the patient’s particular situation.

Also see: Why urology residents should care about health policy

U.S. Preventive Services Task Force recommendation and AUA response. In 2012, the United States Preventive Services Task Force (USPSTF) issued its own recommendation on screening, which was incongruent with current practice. The “D” grade given by the USPSTF suggested that there was no role for PSA screening. This is the subject of much debate. In November 2015, the USPSTF proposed a revised analytical framework for prostate cancer screening that was opened for public comment. The AUA leadership published thoughtful comments in response to this outline, which can be found here.

Next: "I recommend reading what our patients and colleagues are reading."

In the news. I recommend reading what our patients and colleagues are reading. The Wall Street Journal reaches a large audience and recently published two articles relevant to the PSA discussion; one of them highlights the apparent decline in prostate cancer diagnosis albeit related to the decline in PSA screening, while the other article reports on a proposed clinical quality measure of the Centers for Medicare & Medicaid Services that could negatively impact prostate cancer and PSA screening.

Educate. I urge you to take the opportunity to educate your colleagues by volunteering to present at your institution’s advanced practice provider grand rounds. As the urology expert, also consider presenting on the topic of PSA screening at the state or national level. Urology topics are often underrepresented at primary care conferences.

Provide resources. The AUA website is an excellent resource. I often refer my colleagues to a press release from May 17, 2015 titled “Impact of U.S. Preventive Services Task Force Guidelines Raises Concerns.” This press release highlights three important studies showing new research related to primary care trends in prostate cancer screening:

• Trends on PSA Utilization by Primary Care Physicians: Impact of the USPSTF Recommendation. Publication Number: PD44-02

• Deficiencies in PSA Screening Practices in Black Men Aged 55-59 in the United States. Publication Number: MP77-13

• Changes in Primary Care Provider Practice Patterns Since 2012: Impact of the USPSTF. Publication Number: MP16-20.

In my practice, I regularly refer to the AUA guideline, “Early Detection of Prostate Cancer.” It is useful to have these on hand to recommend the best available evidence.

These guidelines are evolving and all are looking for balance. Please feel free to share your perspectives.

Have you read:

Can Gleason 7 cancer be low-risk disease?

New PCa test outperforms PSA in men with Gleason ≥7 disease

How much does treating low-risk PCa really cost?

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