Experts respond to USPSTF swipe at PSA screening

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The U.S. Preventive Services Task Force (USPSTF) issued a Grade D rating for prostate-specific antigen (PSA)-based screening for prostate cancer on May 21, a move that could result in fewer men being diagnosed with early, curable prostate cancer and more men presenting with advanced stages of disease.

According to the USPSTF, there is "moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." The American Urological Association (AUA) responded swiftly, and issued a statement asserting its position.

“The AUA 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. 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. But not all prostate cancers are life-threatening. 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.”

Seth Rosenthal, MD, vice chair of the American College of Radiology radiation oncology commission, said in an interview with Health Imaging, “PSA-based screening has identified a large group of patients with early, curable prostate cancer who can be treated with radiation therapy or surgery. Death rates have been declining, despite the increased incidence of prostate cancer nationwide.”

According to the AUA, prostate cancer-specific mortality in the U.S. has dropped 40 percent in the most recent 20 years of PSA-based screening, without substantial change in how men with prostate cancer were treated. The organization cited models suggesting that more than 50 percent of the reduction is due to early detection (Cancer Cases Control 2008;19:175-181).

“It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations, such as African American men. Men who are in good health and have more than a 10-15 year life expectancy should have the choice to be tested and not discouraged from doing so,” AUA president Sushil S. Lacy, MD, said in a statement.

One potential consequence of fewer men undergoing screening is more patients presenting with advanced stage disease, when potential morbidity of treatment may be greater and cure rates may be lower, said Rosenthal.  

“A blanket recommendation not to do screening on all patients is inappropriate and potentially going to deny patients access to early diagnosis,” cautioned Rosenthal, adding that prostate cancer treatment is most effective for patients at earlier stages of the disease.