U.S. Preventive Services Task Force report on PSA is another reason for men to avoid the doctor, urologists say

July 1, 2012

Most urologists say they've already seen reaction to the report's release and the resulting news coverage. Many are concerned that the USPSTF recommendation will give men another excuse to avoid the doctor's office.

In May, the U.S. Preventive Services Task Force (USPSTF) issued its final recommendation on the use of the PSA test as a screening tool for prostate cancer. The task force upheld its original grade D recommendation, saying there is no evidence the test helps reduce deaths from prostate cancer but significant evidence shows unnecessary testing and treatment can result in lasting harm to patients.

With the announcement coming in the middle of the AUA annual meeting, organized urology was armed with a prepared, consistent message of its own. The AUA called the statement "inappropriate and irresponsible." The question now is, what impact is the recommendation having on urologists in community practice?

Urology Times posed that question to practicing urologists across the country. We also asked: How are you addressing the new round of questions about PSA testing posed by confused patients? What are you telling referring physicians about the report? And how concerned are you that health insurers will cut reimbursement for PSA testing?

Vincent Bivins, MD, in Homewood, AL, saw an immediate response.

"Patients canceled biopsies. Even patients with aggressive tumors scheduled for treatment are now concerned and want to delay treatment," Dr. Bivins said.

"In the studies the recommendations were based on, the average screening was just 5.8 years," he said. "You need at least 13 years of screening to see if there's a difference in prostate cancer mortality. They didn't allow enough time for the disease to progress to see if there's a difference in mortality [in screened and unscreened men].

"The second problem is that roughly half the patients that were used as non-PSA patients had actually had PSA tests, so the control group was contaminated."