USPSTF Backs Away from PSA Screening Ban
The mission of the U.S. Preventive Services Task Force (USPSTF) is to evaluate the benefits and harms of health services for primary care physicians. On April 11, 2017, the USPSTF issued a new draft recommendation that no longer deprives men of PSA screening, but rather encourages men to discuss prostate cancer screening with their doctor and decide for themselves whether they want to be tested.
The Task Force performed a new review of available scientific evidence and determined that the potential benefits of screening outweigh the harms for men aged 55 to 69 years. For men in this age group, the recommendation against PSA testing has been upgraded to a Grade C (shared decision making with their doctor) from a Grade D (do not screen). However, the Task Force continues to recommend against PSA testing for men age 70 and older.
Nearly 180,000 U.S. men are diagnosed with prostate cancer each year and about 26,000 die from it, making it one of the most common and deadly cancers among men. During the PSA screening era (1991-2008), there has been an 80% decrease in the percentage of patients who have advanced prostate cancer at the time of diagnosis and a greater than 50% decrease in the prostate cancer death rate. Despite this, in 2012, the Task Force issued a surprise recommendation against all PSA screening, stating that the harms outweighed the benefits. This grade D recommendation, depriving all men of PSA screening, prompted a significant drop in PSA testing and an increase in the percentage of patients who have advanced disease at the time of diagnosis.
The new recommendation is not yet final and is currently open for public comment. QUEST will continue to cover the recommendation in future issues.
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Dr. Catalona’s opinion
In an interview with National Public Radio, Dr. Catalona said, “I’m very pleased. I view this as a victory for PSA screening for prostate cancer. PSA screening saves lives, and having the U.S. Preventive Services Task Force discourage PSA screening has sort of created a whole generation of family practitioners and internists who feel that PSA screening is a bad thing to do for patients. If this were to continue, we would lose all these gains in reducing the prostate cancer death rate.”
He wishes the group had gone further and recommended that doctors actively encourage PSA screening beginning at age 40 and continuing past age 70. A baseline PSA measured in men in their 40s is the strongest predictor of metastases and death from prostate cancer decades later. Healthy men aged 70 have a more than 15-year life expectancy, and older men have more aggressive prostate cancer.
Dr. Catalona also regrets that the Task Force does not make a stronger recommendation for African- American men and men with a positive family history of prostate cancer, as both groups have a higher risk for prostate cancer and higher prostate cancer death rates.