What are you telling patients about the U.S. Preventive Services Task Force recommendation on prostate specific antigen-based screening?


Urologists generally use the recommendation as the basis of a frank discussion with patients.

"I try to follow AUA guidelines, but there are conflicts, so I also try following studies showing that a 0.5 ng/mL PSA on a 50-year-old probably doesn't need to be redrawn for 3 to 5 years.

For a 65-year-old with a 1.0-1.5 PSA, doing a PSA annually doesn't make much sense. Alternately, if he has a higher PSA, getting a baseline, a prostate ultrasound, and plotting the PSA progression yearly makes sense to me.

I'm trying to work with this preventative idea and save money, but also to practice good urology. I tell patients what the literature says, and what I know, to help them make their mind up."

"I've written extensively on this topic, and many of my papers were quoted by the task force. Urologists should read the report; the task force's methodology was sound, and their conclusion that there's a paucity of studies supporting prostate screening is true.

For men with a life expectancy 10 years or less, PSA is probably worthless. We don't know yet if it's useful for men in their 50s and 60s.

That doesn't mean we should throw it all out; we should wait for the big European trial to run 5 years; that's when I think we'll have a better idea on PSA testing."

Peter C. Albertsen, MD
Farmington, CT

"I tell them the task force recommendations were based on flawed research. I can't argue with what they said, which was if there is no good data to support doing something, you shouldn't do it. That's generally true, but the research has been poor.

We might be better off not doing as much PSA testing, but a lot of men in their 40s and 50s who may not get tested because of the task force's recommendations could die. We could be throwing the baby out with the bath water."

Douglas E. Sutherland, MD
Lakewood, WA

"We tell patients the task force doesn't recommend it, primarily for concern about overtreatment of disease that may be better-served by active surveillance. We say PSA is the best screening mechanism we have right now, so if patients are interested in screening, we offer it to men under the age of 75.

Then we have frank discussions about whether they want to move forward with a biopsy. There's a growing awareness that some patients are better served with active surveillance than active treatment."

Will Lowrance, MD, MPH
Salt Lake City

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