The American Association of Clinical Urologists (AACU) rejects the USPSTF's complete disregard of the positive effect the PSA test has had on so many men in this country.
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The title of this article says it all. Recently, the U.S. Preventive Services Task Force (USPSTF) finalized its recommendation against PSA-based screening for prostate cancer. The USPSTF’s new position replaces the 2008 recommendations, which cited insufficient evidence to support improved health outcomes associated with prostate cancer screening for men younger than 75 years and more conclusive evidence pointing to more harm than benefit for men aged 75 years or older. As a result of the recommendation, public programs and private insurance companies will consider denying coverage for the PSA test, leading many men to forgo screening and risk developing aggressive prostate cancer.
The American Association of Clinical Urologists (AACU) rejects the USPSTF’s complete disregard of the positive effect the PSA test has had on so many men in this country. The PSA test detects both cancerous and noncancerous prostate gland abnormalities. Thanks to early detection from a PSA test, 90% of all prostate cancers are discovered before they spread. At this early stage, the survival rate is nearly 100%. Patient-centered consultation and decision making is vital at every stage of this process, from whether a PSA-based screening is justified to test results, to additional tests and diagnosis, to varied management options.
The key studies used by USPSTF as a basis for this recommendation are severely flawed. Some of the major flaws in the studies include: PSA testing had been performed in many of the "non-screened" control group, there was a relatively short time of follow-up with death from prostate cancer as the endpoint, and no consideration was given to metastasis-free rates as an important outcome. The last point is particularly worrisome because men with metastatic prostate cancer often suffer a protracted, painful course before death from the disease.
The USPSTF contends that screening with PSA leads to unnecessary testing and overtreatment. The task force recommendation against PSA testing blatantly ignores the many studies addressing tumor behavior and patient outcomes that have helped establish appropriate clinical guidelines on prostate cancer management. These studies and guidelines have resulted in the expanded use of appropriate surveillance protocols. After shared doctor-patient decision making, many men with low-risk prostate cancer are appropriately placed on watchful waiting.
The recommendations are misleading and harmful. They ignore the nearly 30,000 men who suffer a prolonged course of illness then die from prostate cancer each year. The recommendations do not adequately consider the high-risk patients such as those with a family history of prostate cancer and African-Americans, who as a race are at the highest risk of developing high-grade cancer of the prostate. The USPSTF does not include a urologist and ignored the opinions of experts in the field. We must rebuke a recommendation that will place many men’s lives in danger and set us back 20 years in our progress to save patients from suffering and dying from this disease.
For all of the talk against the task force, we are making substantive progress toward change. During the recent AMA House of Delegates annual meeting, the AACU secured overwhelming support from all physicians for a resolution calling for reform of the USPSTF. We fully expect Congress to take up this matter legislatively in the near future.
More than two million men are alive today because of early detection and improved management of prostate cancer. We must continue to encourage physicians to speak freely to their patients about PSA-based screening for prostate cancer and endorse informed decision making.
AACU encourages all readers to share this information with your patients and your primary care colleagues. Ask them to contact their elected officials and urge them to reject the USPSTF recommendation. We must move forward in our efforts to protect the well-being of men across this country.
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