USPSTF changes guidance on testing for risk of prostate cancer

As yet we have not seen the details, but, according to a report on National Public Radio early this morning, the US Preventive Services Task Force (USPSTF) has stated that men up to age 70 should discuss the risk and benefits of PSA testing with their doctors and then make individual decisions about whether to get tested.

We will have more to say about this later in the day, when we have had a chance to review the revised recommendations in detail. At present all your sitemaster can tell you is that:

  • The task force was convinced by the combination of data from the major European screening trial (the ESRPC trial) which showed a decrease in risk for metastatic disease combined with the increasing acceptance of active surveillance that is cutting (somewhat) the risk for over-treatment, and that …
  • Even Dr. Otis Brawley of the American Cancer Society is pleased by the revisions to the USPSTF’s recommendations

4 Responses

  1. Thanks for this and your later report.

    I’ll be interested in Dr. Brawley’s comments as he has been so surprisingly opposed to screening over the years. At one point he clearly did not understand the problems with PLCO and the significance of the ERSPC results that demonstrated a screening benefit.

    I’ve seen him present or comment as an advisory committee member a number of times — even having brief conversations twice, and he strikes me as an intelligent, thoughtful, caring physician who is experienced in prostate cancer oncology from his Emory days. That’s why I cannot understand his long-term resistance and failure in those years to embrace active surveillance to avoid harms of screening. It would be good to have him on the side of smart screening.

  2. Dear Jim:

    This is what Dr. Brawley is quoted as having said in a report on NPR early this morning:

    “I really do think that there is a pendulum in a lot of things that we do in medicine,” Brawley says. “And the pendulum here may be getting to the right place where we realize there are harms and there are benefits and individuals need to weigh these harms and benefits and tailor a decision that’s right for them.”

  3. … So, at age 70, they kick you to the curb eh? Good thing I caught it at age 72, 5 years ago!

    Fixed it, in the clear for 5 years … no thanks to the government, I guess …

  4. Dear Natron:

    The recommendations of the USPSTF are independent of “the government”. See this quotation from the actual document:

    Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

    And if you read the full text of the recommendation with care, what they say is that

    The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men age 70 years and older do not outweigh the expected harms.

    They say this because there are no good data to suggest that the potential benefits outweigh the potential harms for the majority of men > 70 years of age. This does not mean that an individual and his doctor can’t determine that, in individual cases, PSA testing may be appropriate.

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