The USPSTF on “implementation” of their recommendation


There is a critically important portion of the USPSTF recommendation that few people seem to be noticing or acknowledging. It reads as follows:

Implementation

While the USPSTF discourages the use of screening tests for which the benefits do not outweigh the harms in the target population, it recognizes the common use of PSA screening in practice today and understands that some men will continue to request and some physicians will continue to offer screening. An individual man may choose to be screened because he places a higher value on the possibility of benefit, however small, than the known harms that accompany screening and treatment of screen-detected cancer, particularly the harms of overdiagnosis and overtreatment. This decision should be an informed decision, preferably made in consultation with a regular care provider. No man should be screened without his understanding and consent; community-based and employer-based screening that does not allow an informed choice should be discontinued.

This statement occurs about one-third of the way through the full draft of the recommendation.

In addition, there is a statement at the top of the recommendation that reads as follows:

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

3 Responses

  1. The shame is that this information was not provided by the media and other sources in the first place. We were only told that the task force would be recommending that PSA testing no longer be offered to men. The information now provided should be seen by health insurers as reason to continue coverage for PSA testing under the conditions explained. Certainly puts a different slant on what we were first provided.

  2. Now Chuck … A man of your youth and experience should be wise enough not to believe everything you read in the papers!

    :O)

  3. I hate to admit it, but I failed to open the reference to the “full paper” when reading your October 7th post. Now that I’ve read the entire paper, it is a reasonable assessment of how PSA results have resulted in way too many invasive treatments when active surveillance was warranted. And the paper still leaves open the choice of physicians to bring prostate cancer awareness to their patients, explain the PSA test and digital rectal exam, and leave it to the patient whether or not he would like to be tested/examined. The onus will, as I have stated many times in the past, be on the physician providing the PSA and DRE to thoroughly explain why a biopsy may be recommended, all treatment options including active surveillance, depending on diagnostic results; and more so to encourage active surveillance to those patients with low grade, low percentage, early developing prostate cancer to avoid as long as possible the invasiveness and side effects that accompany surgical removal or radiation of the prostate gland.

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