The PSA screening dichotomy continues to make news

A research letter just published in the Journal of the American Medical Association this week confirms what most physicians and prostate cancer advocates were already well aware of … that the U.S. Preventive Services Task Force (USPSTF) recommendation from 2008 — that men of 75 years and older should not generally be given annual PSA tests to screen for prostate cancer — was pretty much ignored by all concerned.

According to the study by Prasad et al., which was based on an analysis of data from the National Health Interview Surveys conducted in 2005 and 2010:

  • In 2005, 43 percent of men aged 75 and older underwent screening for prostate cancer.
  • In 2010, 43.9 percent of men aged 75 and older underwent screening for prostate cancer.

The full text of the study is not available on line, but it is discussed in some detail in articles in The Huffington Post and The Boston Globe. Indeed, according to the article in The Boston Globe, the rate of PSA testing for prostate cancer is actually higher among men of 75 years and older than it is among men in their 50s. The highest screening rate is among men aged between 60 to 74 years — at 51 percent.

Much of the media discussion related to this article is focused on the implications of this finding in relation to the current draft recommendation issued by the USPSTF in 2011 that annual, PSA-based screening for  prostate cancer should not be recommended at all.

A quite separate piece of research by Pollack et al., just published in the Archives of Internal Medicine, is discussed in an article on MedPage Today. According to the report on MedPage Today, Pollack and his colleagues surveyed 141 eligible doctors associated with Johns Hopkins Community Physicians, which is composed of 26 outpatient sites in 11 counties in Maryland. The resulsts of this survey can be summarized as follows:

  • 88.7 percent of the 141 physicians surveyed responded to the survey.
  • More than 90 percent of the respondents were aware of the latest USPSTF draft recommendation.
  • 49.2 percent of the respondents agreed or strongly agreed that the recommendations were appropriate.
  • 36.0 percent of the respondents disagreed or strongly disagreed that the recommendations were appropriate.
  • 14.8 percent of the respondents neither agreed or disagreed.
  • When asked if the recommendation would actually change their clinical practice
    • Just 1.8 percent of respondents said they would no longer order routine PSA tests.
    • 21.9 percent said that they would be much less likely to order routine PSA tests.
    • 38.6 percent said that they would be somewhat less to order routine PSA tests.
    • 37.7 percent said that they would not change how they order PSA tests.

It is increasingly clear that there are major divisions among the medical community about the appropriateness of routine PSA testing as a means of screening for prostate cancer. We are not going to be able to resolve this issue based on the currently available data, and it is to be hoped that “reason” will prevail at least to the extent that appropriate PSA testing will still be widely available for the men who most need it because of specific risk factors (including risk based on a baseline PSA value taken for most men some time between about their 40th and 50th birthdays).

2 Responses

  1. Realistically, what harm is done by allowing all men, regardless of age, to know whether they may have prostate cancer? Let them know the facts and then allow them to collaborate with their physician and make their own treatment decision.

  2. James:

    The problem is that there is no agreement about “the facts” … which is why you see the differences of opinion among the physician community illustrated above.

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