USPSTF Prostate Cancer Screening Recommendation Challenged

The results of a clinical trial that recommended against PSA testing have now been called into question by US researchers.

PSA (prostate-specific antigen) is a protein produced by prostate cells.  The PSA blood test is done to help diagnose prostate cancer and is also utilized to monitor cancer recurrence.   In May 2012, the U.S. Preventive Services Task Force (USPSTF) released a statement which recommended against PSA based screening for prostate cancer, citing the test often produces false-positive results.  

 As the USPSTF is now in the process of updating  these controversial prostate screening recommendations, new evidence gives further support to the idea that the recommendations were misguided in the first place.  A reanalysis of the study that strongly influenced the USPSTF recommendations ― the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial ( N Engl J Med.2009; 360:1310-9) ― has raised more doubt about the trial and its conclusions.

Dr. WatersW. Bedford Waters, MD, former President of the American Board of Urology (ABU), Chief in the Division of Urology at the University of Tennessee Medical Center, Graduate School of Medicine, and a urologic oncologist, says the controversy regarding prostate cancer screening continues to present conflicting data.  “I feel the USPSTF decision is ill-advised and based on flawed data. There were no urologists or medical oncologists on the panel. There is data showing that screening for prostate cancer has decreased since the recommendation. At the same time there has been some convincing papers showing that the diagnosis of high grade prostate cancer is increasing. There has to be a balance between diagnosing low grade prostate cancer in patients who don’t need to be treated and missing high grade tumors that will kill patients. What we need is smarter screening:

1. Obtain a baseline PSA at 40 – 45 years of age in  patients with a family history of prostate cancer or if the patient is African-American. If the PSA is < 0.5 ng/ml, that patient can be screened every two to three years.

2. Screening is not recommended for patients if they have less than a 15 year life expectancy or have many medical co-morbidities.

3. The AUA Guidelines recommends that clinicians discuss the pros and cons of the PSA test with men who are 55 to 69 years of age. For those men being screened, the AUA recommends 2-year PSA intervals, with longer intervals for men over 60 with PSA levels

 4. There is no consensus on screening over the age of 70, one has to look at the total patient, his overall health, and co-morbidities. Some men over 70 years of age who are in excellent health might also benefit from screening, but the risk of harm increases and the chance of a benefit decreases with age.

This controversy may never be solved, but we have to take care of patients and use good common sense.”

 For more information about prostate cancer or PSA testing, visit University Prostate and Urology Cancer Center, or call 865.305.9254.