Ten members if the Prostate Cancer Roundtable have, this morning, issued a media release supporting proposed legislation in Congress designed to revise the activities and functions of the U.S. Preventive Services Task Force (USPSTF). The American Urological Association also supports the proposed bill.
The proposed legislation is known as the USPSTF Transparency and Accountability Act of 2012 (H.R. 5998). The media release issued by the 10 signatory organizations among the members of the Prostate Cancer Roundtable is available on the Roundtable’s web site. At the time of posting this message, the full text of this bill is not available on the “Thomas” web site.
The two members of the Roundtable that have not signed on as supporters of this peice of legislation are Prostate Cancer International (the parent organization of this web site) and the Prostate Cancer Foundation.
Prostate Cancer International (PCI) is of the opinion that the proposed legislation is simply not constructive, will go nowhere, and is based on a fundamental misunderstanding of the function and role of the USPSTF. PCI respects the fact that others have different opinions, and PCI further understands that there were serious flaws in the way that the USPSTF packaged its recent recommendation about prostate cancer screening. However, we do not believe that legislation of this type is any way to resolve what is basically an educational issue.
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“PCI respects the fact that others have different opinions …”
Thank you, since I do.
PSA testing has reduced the deaths in men due to prostrate cancer by 40%+…. Why do we want to suspend PSA testing? Not enough men dying of prostate cancer??!!
Dear Jorge:
I am not aware that anyone is suggesting that we “suspend PSA testing” of individuals at risk for clinically significant prostate cancer.
The question under debate (as it has been for some 20 years) is whether we are inappropriately using PSA “screening” to find clinically insignificant prostate cancer in otherwise healthy men who are at no actual risk form this form of cancer but are at risk of significant harms from the consequences of a diagnosis and treatment that they do not in fact need.
All right it has been misunderstood, all this fuss about PSA is really about its proper use … but then what about PCA3?
PCA3 is really not such a great advance over the PSA test.
It can’t be used to actually diagnose prostate cancer. It has many of the same problems as the PSA test in terms of its accuracy. Like the phi test, it may reduce the overall number of biopsies that are needed each year (but it may not). There is no indication that it can clearly differentiate between risk for clinically significant and risk for clinically insignificant disease in individual patients. And furthermore it is far more expensive than a PSA test.
Dear Sitemaster,
1. ‘I am not aware that anyone is suggesting that we “suspend PSA testing” of individuals at risk for clinically significant prostate cancer.’
The issue is who or what panel determines which men have a “significant risk” of developing prostate cancer. My understanding of the USPSTF opinion is men will have to prove to their Health and Hospital Insurance providers they belong to this group [of "individuals at risk for clinically significant prostate cancer"] in order to obtain a “paid” or “plan covered” PSA test. It will no longer be a personal decision between any man and his physician. Would the USPSTF opinion and the risk not following it create an increase in the “legal risk” which would inhibit doctors from ordering a PSA test even if the patient is considered to be within this “select group” of men?
2. ‘The question under debate (as it has been for some 20 years) is whether we are inappropriately using PSA “screening” to find clinically insignificant prostate cancer in otherwise healthy men who are at no actual risk form this form of cancer but are at risk of significant harms from the consequences of a diagnosis and treatment that they do not in fact need.’
To my knowledge men and their doctors are using the PSA test to evaluate changes between various readings as an indicator of PROBABLE prostate cancer. The USPSTF OPINION seem to start with the premise of: All men should NOT be screened for prostate cancer (PCa). Because just by these men knowing there is a probability they have PCa will cause them to seek validation of their condition by means of a biopsy. The USPSTF seems to take the position men do not need validation of the probability they have PCa.
We all know the PSA test is not highly reliable AND the only validation of a PSA reflecting a PROBABILITY of PCa is a biopsy. AND we all know a prostate biopsy samples a very small portion of the prostate gland’s volume (3% to 5% depending on the number of sampling needles used) AND there is a significant probability of the biopsy missing the actual PCa tumors giving a FALSE NEGATIVE.
The USPSTF seems to further take the following position: Once a positive biopsy validates PCa is PRESENT within a patient; the patient and his physician are NOT EDUCATED ENOUGH to select an option for treatment best suited to the patient’s condition. BECAUSE OF THIS the USPSTF CONTENDS much of the treatment all PCa patients undergo is unnecessary and puts men at significant risk from their treatment. According to the USPSTF the risk from this treatment seems to be of a higher medical risk than the PCa condition itself.
The USPSTF completely IGNORES the PSA Test has reduced PCa mortality by 44% since the mid 1970 when the test was first introduced.
It could be the USPSTF does not trust our medical education system or the AMA right to provide oversight of the medical profession and sees a need to “SAVE” men from their doctor’s lack of judgement or the ABILITY of these doctors to workout a treatment protocol with their [ignorant?] patients. Am I upset? Yes!! I do not like my liberty of choice of treatment taken away by a board that does not seem to know much about breast cancer or PCa.
Dear Jorge:
You — like others — are entitled to your opinions. However, it appears to me that you may not have read with care the entire text of the document issued by the USPSTF and that you are reacting primarily to the appearance of their recommendation as opposed to what they say in the full document. You are certainly making a series of unsubstantiated assumptions about the consequences of the recommendation that (as far as I am aware) have not been implemented by anyone. The USPSTF has neither stated nor implied anywhere that physicians should not use their clinical judgement as to the need for a PSA test in specific individuals.
So that we are clear, I am in no doubt at all that the USPSTF is badly in need of some skilled assistance with their communications program, but I am also in no doubt that the mass, population-based “screening” of otherwise healthy men on an annual basis with PSA tests is not justified by any scientific evidence at all. That is what the USPSTF is recommending against. It is worth noting that several of the key authors of the major European screening study have actually come to exactly the same conclusion. (A fact that is being largely and conveniently ignored by the American Urological Association and most of the rest of the US prostate cancer community.)
The USPSTF is not saying at all that you as an individual shouldn’t have a PSA test if you and your doctor think it is a good idea.
Despite the desire in many quarters to see all this as either a “black” or a “white” issue (i.e., all or nothing), it is in fact mostly colored in shades of gray. Appropriate decisions about the use of PSA testing need to be and should be made on an individual basis.
I am the 15-year survivor of seriously advanced prostate cancer who survives because of a PSA test. I am also a long-time participant in most phases of activity related to prostate cancer, including facilitating an active support group. That said, I wholeheartedly support PCI’s position on the proposed legislation and its interpretation of the USPSTF recommendation and report. I especially agree with its statement that prostate cancer screening is an educational issue. We should be directing our effort to education rather than by wasting our time and resources on attacking the USPSTF.
Thank you Ben. I sometimes feel like I am the only dog barking, so I appreciate your support!
:O)
USPSTF IS AGAINST MORE THAN JUST MASS SCREENING
Hi Sitemaster,
I join in your concern about mass screening programs of men who have virtually no knowledge of prostate cancer, particularly of the role of active surveillance for men with “low-risk” cases. However, after reading the USPSTF report, I am convinced the Task Force went well beyond that, providing comments and profoundly flawed figures that undermined the worth of soundly done “screening,” or “early detection” if you prefer that term.
I am convinced the USPSTF needs some kind of balance from people who have knowledge of the disease being examined. Perhaps the Roundtable can help achieve that.