USPSTF on PSA Testing for Prostate Cancer

The US Preventive Services Task Force published their final recommendation update on PSA screening to detect early prostate cancer.  The USPSTF is the most unbiased and science-based organization in the US.  It is free from bias, and scrupulously maintains a strict conflict of interest policy.  It’s members do not have a financial interest in the outcome of the analyses done, like the American Urological Association might have for PSA testing, nor do they have a conflict of commitment – a worldview that catching cancer early is a prime overwhelming driving force, like the American Cancer Society has had in the past.  (I think the ACS has been much more nuanced and reasoned in their responses in the past few years as compared with the past.)  The AUA has announced that it is “outraged and believes that the Task Force is doing men a great disservice by disparaging what is now the only widely available test for prostate cancer, a potentially devastating disease.”  I think the AUA is wrong, and that the USPSTF’s recommendation is more balanced and reasoned than the AUA states.

Basically the USPSTF claims that there are reasons not to screen for prostate cancer using current techniques, especially the PSA test.  The summary:

The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years. 
Grade: I Statement

The USPSTF recommends against screening for prostate cancer in men age 75 years or older.
Grade: D Recommendation

Paul Menzel and I have written about a number of factors which should be involved in recommendations and/or resource allocation associated with prevention screening, and I won’t repeat those items in this blog.  I will mention, however, that Diana Petitti’s chapter 5 of our book, Prevention vs. Treatment:  What’s the Right Balance? looks at some of those issues as well from a former USPSTF member’s insider view.

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  • Lee Levin  On May 22, 2012 at 5:34 pm

    Halley, I still screen for prostate cancer in my patients but less frequently, I have many men about 300 or so on testosterone replacement and I do screen in then, even if the PSA is high I tend to do little except follow it, My referrals for prostate biopsy have vanished, I guess less business for the urologists. Lee Levin

    • Halley Faust  On May 22, 2012 at 9:43 pm

      I don’t believe the USPSTF addresses the special circumstances of testosterone replacement. In any screening recommendations if high risk individuals are not separately assessed then the recommendation goes to the low risk individuals and I agree that high risk individuals need special consideration – as you are doing, Lee.

  • Lee Levin  On June 3, 2012 at 2:59 pm

    I took considerable additional training and was board certified in Anti aging medicine, this is not an officially recognized subspecility but a sub specialty none the less. It involves lifestyle interventions such as as diet, exercise,stress reduction and hormone replacement when medically indicated. The theory being that if one follows these recommendations you will experience an improved quality of life, this hopefully will result in an extension of years of quality life. It is difficult to run a double blind 50year controlled study re this. This sub specialty can be viewed as an aggressive proactive form of preventive medicine. Lee Levin

  • Halley Faust  On June 2, 2012 at 7:52 pm

    Based on an anecdote and ecological study one should make no statements about effectiveness of a screening test. The “Bad ‘Evidence’…” posting is of little value in evaluating PSA screening.


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