USPSTF Recommends Against PSA-Based Screening for Prostate Cancer

In a very debatable move, the US Preventive Services Task Force has recommended against screening for Prostate Cancer with a PSA test, for men with no other clinical evidence of the disease. The recommendation is for all men, regardless of age, family history, race or any other factor. They classified the recommendation as a “Class D” item, meaning that “The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service.”

Most urologists agree that many men with prostate cancer could potentially be spared the complications of prostatectomy or other treatments of prostate cancer. But they also agree that it is very difficult to determine which men would most benefit from therapy and which should be observed. The USPSTF is correct in stating that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. They are also correct that after age 70, screening does not reduce death rates from prostate cancer. The reason for this is that it takes a long time in many cases for prostate cancer to cause death. It is a slow-growing disease in most cases and takes a very long time to act in most men. But in a small number of men the disease is quite rapid, and it seems a shame to ignore this possibility.

The word “overdiagnosis” is used to describe the effect of using PSA screening to find prostate cancers that will not adversely affect the longevity of the patient. I think this is the wrong word because finding a diagnosis is much different from deciding what to do with that diagnosis. I would prefer to say that prostate cancer is “overtreated” and this is probably true. Complaining about finding a diagnosis is like putting your head in the sand to avoid seeing something. I think most men would like to know if they have a cancer so that they can manage the implications of this finding over time. It seems far better to deal with a known than to abandon screening and pretend it does not exist. So while the USPSTF takes a cold look at the numbers and makes a recommendation that would save a lot of time and money, it does men injustice to simply ignore a disease that could seriously harm their quality of life and longevity if allowed to progress out of control. I believe that PSA screening should continue, and that observation protocols should be created to correctly stratify men into groups to observe, and groups who need early action.

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