As many readers will be aware, the U.S. Preventive Services Task Force (USPSTF) is in process of developing a new “evidence report” which will form the basis of any update to current USPSTF recommendations about prostate cancer screening.
The following statement was issued to its members this morning by the American Urological Association:
We are pleased to share with you exciting news that the … USPSTF … has selected an AUA-nominated urologist to independently review the evidence report that will inform updated recommendations on prostate cancer screening. As we shared last month, the AUA nominated three urologists in response to a formal request from the USPSTF.
As you know, the AUA is a long-standing advocate for USPSTF reform, and has worked actively with U.S. Representatives Marsha Blackburn (R-TN-07), Bobby Rush (D-IL-01) and other lawmakers to advance legislation on this important issue. In November, the AUA provided testimony supporting USPSTF reform to the House Energy & Commerce Subcommittee on Health and, most recently, announced support for H.R. 539, the USPSTF Transparency & Accountability Act of 2017, introduced on January 13 by Reps. Blackburn and Rush.
“We truly appreciate the USPSTF’s inclusion of urologists on this important panel and its willingness to consider the AUA’s nominations,” said AUA President Dr. Richard Babayan. “This is an important first step toward the transparency we seek in our efforts to reform the Task Force.”
“We believe that input from a urologist will be meaningful and impactful relative to developing recommendations that the prostate cancer community as a whole can support.”
Ensuring appropriate access to prostate-specific antigen screening and reforming the USPSTF remain top priorities for the AUA.
Whether the unidentified, AUA-nominated urologist will agree with the findings of the evidence report currently in preparation, and whether the USPSTF will necessarily agree with any comments made by this AUA-nominated reviewer that may dispute or be critical of the findings of the new evidence report is, of course, completely unknown. We shall need to monitor how that plays out over time.
Filed under: Diagnosis, Risk | Tagged: PSA, risk, screening, USPSTF |
THE "NEW" PROSTATE CANCER INFOLINK 
Applauding This Important Step!
I’m sure many of us strongly urged the USPSTF to add someone with real expertise in prostate cancer to participate in its current review of prostate cancer screening guidelines. Most unfortunately, the Task Force did not do this during the period for formulating its research plan, which resulted in a deeply flawed plan. Also, at this point the AUA expert will apparently not be an ad hoc member of the voting panel. However, better late than never. I’m eager to learn which urologist will be reviewing the evidence report.
Hopefully the AUA expert will be able to explain to the Task Force the effect of relatively short follow-up from diagnosis, the steep reduction in the number needed to invite to screening per life saved by screening with each 2 years of added follow-up, the key role of active surveillance in preventing over-treatment, and other critical considerations which the Task Force has to date shown little capacity to appreciate.
I just checked to see if the ERSPC had given another update of the key data. It hadn’t, but there were some very interesting analytic reports, including one that reflected the remarkable impact of active surveillance in reducing adverse consequences of over-detection, a major concern of the Task Force, which has given only lip service to active surveillance in the past. That paper, by A. Auvinen et al., includes the following key finding:
“When patients treated with active surveillance were excluded, the extent of overdetection was strongly reduced in Sweden (NNO increased from 22 to 41), Finland (from 51 to 137) and Switzerland (from 18 to 34), where active surveillance was commonly used, and also to some extent in Belgium (from 47 to 62), but the difference was not substantial in the other centers (in the Netherlands from 16 to 19, Italian and Spanish results almost unaltered due to infrequent use of active surveillance).”
“the USPSTF Transparency & Accountability Act of 2017, introduced on January 13 by Reps. Blackburn and Rush”
What a truly appalling political interference in the scientific process.
This is nothing new, of course. But it can only get worse under the current administration.
It’s a good move by the AUA. I have seen a swing in perceptions by urologists as it pertains to prostate cancer and its treatment in recent years. The USPSTF will definitely benefit from their input. The Timothy Wilt report that led to the Grade D recommendation was seriously lacking input from oncologists and urologists and seemed more like a backlash against over-diagnosis and over-treatment. To some degree deservedly so. However, that report and the Grade D recommendation threw the baby out with the bathwater so to speak. The USPSTF needs to include more than just the PLCO and the ERSPC meta-analysis of trial data and we have better data that screening can in fact save lives. In addition, the Grade D recommendation actually hinders research as well by altering the pool of trial subjects. It is my hope that the USPSTF considers these points before making another recommendation. When they made the first recommendation, they did not consider conservative management seemingly at all. But now it’s a reality.