The U.S. Preventive Services Task Force (USPSTF) has released draft recommendations for the use of prostate-specific antigen (PSA) screening for prostate cancer. The recommendation, which awaits public comment before being finalized, says the decision about whether to be screened for prostate cancer should be an individual one, moving from a “D” recommendation (not recommended) to a “C” recommendation for men ages 55 to 69. The group says screening men in this age group offers a small potential benefit of reducing the chance of dying of prostate cancer, but that many men will experience potential harms of screening, including false-positive results that require additional testing as well as treatment complications, such as incontinence and impotence. We asked Otis Brawley for his thoughts regarding the newly proposed recommendations.
“This is a welcome change, one that puts USPSTF very much in line with the American Cancer Society as well the American College of Physicians and the American Urological Association.
“All of these organizations have moved to a recommendation that doctors discuss the harms and benefits of PSA screening with patients and let patients decide whether to be screened. Some groups, like the ACS, say that discussion should start at age 50; others, like the USPSTF, say age 55.
“The outcome from these groups’ recommendations is that some men will elect to be screened, and others will elect not to be screened; either decision should be supported.
“The USPSTF made this change partly based on additional evidence about PSA screening’s potential to reduce prostate cancer spread and death. Importantly, the group also notes the increasing use of active surveillance, or watchful waiting, when PSA finds a low-risk cancer. That means fewer harms from surgery, which tips the scales towards the benefit side.
“While past screening recommendations were often a simple yes or no, an increasing understanding of cancer has led to more guidelines that now put the decision in the hands of the patient, with guidance and information from their doctor as well as from well-qualified medical/health related organizations.
“The ACS’ last update of recommendations (in 2008) put perhaps the strongest emphasis on shared decision making of any organization to date, including providing decision making tools, as part of the update. While these can be complex issues for patients to navigate, it is imperative they play a central role since it is their lives that are affected.”