PSA Loses with Recent USPSTF Decision
Although comprised of an independent panel of internists, pediatricians, family physicians, gynecologists, obstetricians, nurses, and health-behavior specialists that review the broad scientific evidence for everything in preventative medicine, including prostate cancer screening, the lack of urologists in the USPSTF is somewhat puzzling to me, especially when handling issues in prostate cancer.
To give our readers some background on this decision: In August 2008, the USPSTF published their recommendations for the use of the PSA test to screen for prostate cancer. At the time, the USPSTF concluded that there was insufficient evidence to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years, and recommended against screening for prostate cancer in men age 75 years or older. This recommendation is available here.
On May 21, 2012, the USPSTF released their final update of the 2008 recommendation on prostate cancer screening. They decided not to amend their previous decision, by essentially recommending against PSA-based screening for prostate cancer (grade D recommendation). The results were published online on May 21 in the Annals of Internal Medicine. The latest USPSTF recommendation, which applies to men in the general U.S. population, regardless of age, does not include the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer.
Regardless of the quality of evidence reviewed to make their recommendation, the USPSTF claims that the use of the PSA test for post-diagnostic or post-treatment surveillance of prostate cancer is outside their scope. The USPSTF announcement was met by an immediate response from the American Urological Society (AUA). Outraged by the USPSTF's decision, the AUA believes the new recommendation will do men “a great disservice” by discouraging them from being screened using PSA, the only widely available screening test for prostate cancer.
“We hold true to our current position as supported by the AUA's Prostate-Specific Antigen Best Practice Statement that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients,” said the AUA in their position statement to the USPSTF decision. “Not all prostate cancers are life-threatening, so the decision to proceed to active treatment or use surveillance for a patient's prostate cancer is one that men should discuss in detail with their urologists.”
How will your patients be affected by the USPSTF's surprising decision?
Will you change your clinical practice based on these new guidelines?Readers: We'd love to hear from you in the comments section below! If you have a case study or a more extended response to this subject, click here to submit an item for us to publish.