Prostate Cancer International and The “New” Prostate Cancer InfoLink have never been supportive of the use of annual, mass, population-wide PSA screening of men over the ages of about 40 or 50 years as a way to identify risk for prostate cancer. Rather, we have long supported the need for men to: (a) get a PSA baseline value established when they are in their late 30s or early 40s; (b) talk with their doctors about their personal need for further PSA tests over time based on that initial baseline PSA; (c) take into account any and all other known risk factors that may be relevant to their individual need to monitor their potential risk for prostate cancer using the PSA test and other relevant tests over time; (d) ensure that they are informed and educated about the potential consequences of overly aggressive reaction to an elevated PSA test result.
This position has not always met the approval of the more ardent members of the “pro-screening” community, and we understand their more assertive positions even though we don’t necessarily agree with them.
Having said that, we are not stupid. PSA testing among relevant males — and particularly among men at risk for clinically significant prostate cancer — is important. It is particularly important among men in any specific risk group before any potential signs and symptoms of the disorder are apparent. For this reasons we are strongly opposed to the recent proposal issued by CMS that is designed to discourage the use of PSA testing in men with no signs and symptoms of prostate cancer.
For those who are interested — if you click here — you will find the complete comments submitted to CMS by Prostate Cancer International, with the additional support of The Prostate Net. Other members of PCPC3 are also known to have submitted comment, including the National Alliance of State Prostate Cancer Coalitions (NASPCC) and Malecare.
Filed under: Diagnosis, Risk | Tagged: PSA, screening, test, value |
THE "NEW" PROSTATE CANCER INFOLINK 
As an active practitioner of prostate pathology, I have seen the shift to higher grade prostate cancer at diagnosis since the drop off in PSA testing. Some of my colleagues will be publishing data to this point soon. The CMS recommendation is a recipe for a return to metastatic prostate cancer as the entry point for men in this country. Rest assured our association will be weighing in against this outlandish recommendation.
My thanks for your participation responding to CMS
Just read your comments to CMS and found them to be a reasonable approach to screening. When you state, “A man’s PSA value in his early to mid-40s may well be highly indicative of his lifetime risk for prostate cancer…”, could you please elaborate on what those values might be, which would be cause for concern? I ask because I have two sons in their late 30s. Thank you.
Dear Len:
Most of this information comes from detailed studies by Andrew Vickers and colleagues at Memorial Sloan-Kettering Cancer Center and in Sweden. I would suggest that you (and your sons too) watch this brief video and then look at this specific set of guidelines on the MSKCC web site. Vickers and his colleagues provide detailed guidance for men by age group.
Dear Les:
I think it is important to note that “the shift to higher grade prostate cancer at diagnosis” could well be a good thing IF what it really means is that we are getting better at biopsying only the men at higher levels of risk for clinically significant prostate cancer and not biopsying the men at low and very low risk (i.e., with small amounts of tumor with Gleason grade 6 and lower that is potentially either indolent or does not need immediate early intervention). Of course we do not know if that is the case as yet … and there are very good reasons to worry about that!
Our rate of positive biopsies has also increased since the drop in PSA testing. This does suggest that our urologists are doing an even better job of limiting biopsies to appropriate patients. And with the ascension of active surveillance as a modality in low-grade, low-risk prostate cancer, the risk-benefit ratio is shifting even more toward use of screening. These CMS proposals are outdated before they are even presented.
Amazed at CMS Ignorance!
I should no longer be amazed at the stunning ignorance of bodies like the CMS, but I am. My whole career was in the US civil service, with a 5-year stint in the Navy, and I am always somewhat ashamed when I see an agency of our government performing so poorly.
What especially caught my attention in the CMS announcement was this line: “Thus, the benefits of PSA-based screening are relatively small: screening is estimated to prevent 0 to 1 cancer deaths per 1,000 men screened (Moyer 2012).” Suffice it to note that the level of understanding reflected in that statement is very low, and the data are seriously obsolete.
I have some hope that the CMS will heed the comments linked here.
Shame on the CMS! We deserve a lot better!