Subsequent to issuance of the USPSTF’s final “D” recommendation on the use of the PSA test as a tool to screen healthy males for prostate cancer, the Department of Health and Human Services has already clearly stated that Medicare will continue to cover costs associated with the use of the PSA test as a method to assess risk for prostate cancer. However, appropriate education of men of the risks and benefits of PSA testing is now even more critical.
Some time ago, Prostate Cancer International and Us TOO International collaborated on a basic informational piece designed to help men determine whether they, as individuals, should consider having PSA tests (in association with digital rectal exams or DREs). The full text of this educational information is provided here. Any individual or organization is welcome to use this material and distribute it to men considering whether they should or should not have tests to assess their risk for prostate cancer.
Similarly, Dr. Gerry Chodak has now offered an updated “consent form” that could be given in advance to men considering or potentially considering whether being tested for risk of prostate cancer is appropriate for them as an individual. The data used in this consent form are based on the data presented by the USPSTF, and so some readers may not be entirely comfortable with those data, but the idea behind this consent form is very certainly a reasonable one because it is primarily designed to expand the knowledge of the candidate for testing before he starts down what we all acknowledge to be a potentially “slippery slope” for an otherwise uninformed patient. Dr. Chodak also discusses his thinking behind this consent form on one of his Medscape video blogs.
In thinking about all of these issues, it is important to appreciate the critical difference between the ideas behind “screening” (of all men of a certain age on a specific and regular basis) and “testing” (of specific individuals who wish to be so tested). The “New” Prostate Cancer InfoLink and Prostate Cancer International have long believed that there are few (if any) data to justify the annual, mass, population-based screening of all men (over 50 or any other age) for risk of prostate cancer. On the other hand, we also believe that there are strong reasons for men to establish a baseline PSA in their late 30s or early 40s and then, depending on their known risk factors, to discuss the appropriate future frequency and value of PSA tests and DREs for them, as individuals, with their doctors, with a full appreciation of the facts associated with actual diagnosis and treatment of localized prostate cancer.
We are in complete and utter agreement with the USPSTF on one fact and one fact only. Until we have better tests to assess the risk for and diagnose clinically significant (as opposed to indolent) prostate cancer, we are never going to be able to completely resolve the issue of who should or should not actually receive immediate treatment for localized disease. Until we have such tests, active surveillance is a form of management that is highly appropriate as a first-line strategy for somewhere between 30 and 50 percent of all men newly diagnosed with localized prostate cancer, most especially among the subset of men with a limited life expectancy (based on their age at diagnosis and other factors that are likely to impact their overall mortality).