Virginia A. Moyer, MD, PhD; on behalf of the U.S. Preventive Services Task Force
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Update of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for prostate cancer.
The USPSTF reviewed new evidence on the benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer, as well as the benefits and harms of treatment of localized prostate cancer.
The USPSTF recommends against PSA-based screening for prostate cancer (grade D recommendation).
This recommendation applies to men in the general U.S. population, regardless of age. This recommendation does not include the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer; the use of the PSA test for this indication is outside the scope of the USPSTF.
Screening for prostate cancer: clinical summary of U.S. Preventive Services Task Force recommendation.
What the USPSTF Grades Mean and Suggestions for Practice
USPSTF Levels of Certainty Regarding Net Benefit
PSA-Based Screening for Prostate Cancer
Relative risk of prostate cancer death for men screened with PSA versus control participants, by country.
ERSPC = European Randomized Study of Screening for Prostate Cancer; PLCO = Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; PSA = prostate-specific antigen.
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Carl A Olsson, MD, Chief Medical Officer, John K Lattimer Professor of Urology, Deepak A Kapoor, MD, Chairman and CEO
Integrated Medical Professionals
June 18, 2012
Recommendations Deprive Men of Information That Could be Useful
We would like to comment on the article: Moyer, VA on behalf of the USPSTF. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med 2012; 157 published before print 22 May, 2012. In this article, the USPSTF persists in its D recommendation for PSA screening in the US, citing all their usual and customary arguments against the ERSPC trial while continuing to regard with approval the PLCO trial results, that are so heavily contaminated by pre- and opportunistic screening that prostate cancer specific mortality remains higher in “screened men” even after 13 years of follow-up! (1) Many specific arguments against USPSTF commentaries could be restated (they have been summarized in an accompanying article in the Annals) but the Task Force has shown themselves refractory to these already.( 2) Perhaps, as cited by some critics already, the most distressing aspect of the USPSTF decision process was their not simply evaluating the screening process itself, but deciding to assess harms related to over-diagnosis and over-treatment of prostate cancer (while overlooking the increasing popularity of active surveillance as an option to be considered in managing newly diagnosed prostate cancer- an option that will predictably reduce and may even abrogate unnecessary treatment harms altogether). This concern for protection of the adult American male may be laudatory, but it is also overly paternalistic and deprives the adult man of an extremely valuable bit of information (PSA blood level) which he (perhaps with his physician) has a right to consider (perhaps to use only as a check against future levels). As an entity within the Agency for Healthcare Research and Quality (AHRQ) the USPSTF should be sensitive to the patient having access to all manner of medical information. If one queries the AHRQ website search engine for “be informed” or “get informed” you will find >10,000 “hits”. Regardless of the drawbacks of PSA testing, men should not be subject to surrogate decision-making on the part of the USPSTF; they should be allowed to have PSA levels measured and reported to them and their physicians (“get informed”) rather than being deprived of any information that could be useful to them in considering their own future health options.
Carl A Olsson, MDChief Medical Officer,Integrated Medical Professionals John K Lattimer Professor of Urology(e),Columbia University Medical Center
Deepak A Kapoor, MDChairman and CEO, Integrated Medical Professionals
1. Andriole GA, Crawford E David, Grubb III RL, Buys SS, Chia D, Church TR, Fouad MN, Isaacs C, Kvale PA, Reding DJ, Weissfeld JL, Yokochi LA, O’Brien B, Ragard LR, Clapp JD, Rathmell, JM, Riley TL, Hsing AW, Izmirlian G, Pinsky, PF, Kramer, BS, Miller, AB, Gohagan JK, Prorok PC and for the PLCO Project Team. Prostate Cancer Screening in the Randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: Mortality Results after 13 Years of Follow-up. J Natl Cancer Inst 2012; 104(2): 125-132
2. Catalona, WJ, et al. What the US Preventive Services Task Force Missed in Its Prostate Cancer Screening Recommendation. Ann Intern Med 2012; 157 published before print 22 May, 2012
Thomas E. Finucane, MD
Johns Hopkins Bayview Medical Center
August 3, 2012
To the Editor:Moyer, on behalf of the U.S. Preventative Services Task Force recommends that, “Clinicians should understand the evidence but individualize decision making to the specific patient or situation ”(1). Brawley notes that “the Task Force does leave room for it within the physician-patient relationship…physicians have a special obligation to ensure that the patient understands the proven risks and the unproven benefits of PSA-based screening” (2). In a vigorous rebuttal, Catalona and colleagues propose “that physicians review evidence, follow the continuing dialogue closely, and individualize prostate cancer screening decisions on the basis of patient preferences” (3).Would Catalona and colleagues be willing to estimate, among the last one million American men undergoing radical prostatectomy or radiation therapy with curative intent, how many of these are now alive who would otherwise have died, and how many are alive and suffering impotence, incontinence, diarrhea who would otherwise not be suffering these problems?If not, do they have another way of communicating risks to their patients?
Sincerely, Thomas E. Finucane, MD
1. Moyer, VA. Screening for prostate cancer: U.S. Preventative Services Task Force recommendation statement. Ann Intern Med 2012;157:120-134.
2. Brawley, OW. Prostate cancer screening: What we know, don’t know, and believe. Ann Intern Med 2012;157:135-136.
3. Catalona, WJ, D’AMico, AV, Fitzgibbons, WF et al. What the U.S. Preventative Services Task Force missed in its prostate cancer screening recommendation.
Francis E. Wilkinson, PhD
Manager, CDDG of Frankfort, LLC, Frankfort Indiana
August 13, 2012
Conflict of Interest:
My credentials in this field include a patent for the detection of metastatic prostate cancer that was discovered and developed while I was part of a team of scientists at SmithKlein Beecham and later at diaDexus, which is now in South San Francisco, CA. The patent is 5,747,264. I have also developed a diagnostic kit for determining the risk for coronary artery disease. The marker is the best independent risk factor for coronary artery disease. The kit is being marketed as the PLAC test by diaDexus.
PSA Has High Diagnostic Utility
There are three main areas in my letter that add to what Dr. Catalona and his collaborators said in their rebuttal of USPSTF report: 1) That the age-related death rate for prostate cancer of very young men, who were likely never screened is still the same as it was prior to the widespread use of PSA as a screening tool. 2) The USPSTF report lacks factual information regarding the harms of PSA screening. 3) The USPSTF reports data in a was that makes it appear that lives saved via PSA screening as being virtually zero.I do have an interest in this area as I started a company whose goal is to discover and develop early detection cancer markers for each of the major cancers. If the use of PSA, which I maintain has a very high diagnostic utility, is actually curtailed, it would be foolish for me, or anyone, to spend their lives and resources trying to find early detection cancer markers.
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012;157:120–134. doi: 10.7326/0003-4819-157-2-201207170-00459
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Published: Ann Intern Med. 2012;157(2):120-134.
Guidelines, Hematology/Oncology, Prevention/Screening, Prostate Cancer.
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