USPSTF Upgrades Prostate Cancer Screening Recommendation, Urges Individualized Decisions
Urologists acknowledge improvement, continue to caution against tying test to 'active treatment'
April 11, 2017 – The American Association of Clinical Urologists (AACU) released the following statement by President Charles A. McWilliams, MD, in response to the U.S. Preventive Services Task Force (USPSTF) draft recommendation statement on prostate cancer screening:
The AACU is pleased that the U.S. Preventive Services Task Force (USPSTF) draft statement on prostate cancer screening concludes that the potential benefits and harms of PSA-based screening for prostate cancer in men ages 55 to 69 years are closely balanced. The related C grade for this age group represents an improvement over the Task Force's 2012 recommendation. Indeed, the current draft statement incorporates many of the AACU's longstanding positions and past comments that call for an individualized approach to screening based on an informed discussion between patients and their doctors.
To this end, the AACU acknowledges the targeted review of evidence on the benefits and harms of screening for men at higher risk for prostate cancer, as well as the Task Force's appeal for additional research on prostate cancer in African American men. This reinforces the need for an individualized evaluation of the appropriateness of PSA-based screening based on factors specific to each patient. These factors, of course, include age, and the AACU opposes the Task Force's blanket recommendation against screening for men over the age of 70. With life expectancy growing two-and-a-half years every decade, we believe select men over the age of 70 may benefit from prostate cancer screening.
We continue to caution against associating PSA-based screening with potential harms of overtreatment. Prostate cancer screening does not always lead to prostate cancer treatment. Continuing to tie potential complications with the awareness-raising test does not match up with the Task Force's own acknowledgement that "[active] surveillance has become a more common treatment choice for men with lower-risk prostate cancer over the past several years." We concur with an assessment in the April 11, 2017, USPSTF Bulletin which explains that this disease management strategy offers men "the opportunity to delay active treatment and complications—or avoid active treatment completely."
While we acknowledge that the Task Force recommendation process has become more inclusive since its 2012 statement on prostate cancer screening, more can be done to promote transparency and accountability. Therefore, the AACU continues to call for co-sponsorship and consideration of H.R. 539, the USPSTF Transparency and Accountability Act of 2017.
In all, the AACU believes the draft recommendation released today will reverse troubling trends and ultimately lead to an increase in the early detection of prostate cancer. We look forward to mobilizing the urologic community to ensure that patients and physicians can make informed decisions concerning screening for prostate cancer.
USPSTF website: www.screeningforprostatecancer.org
AACU Federal Action Center: Support Transparency and Accountability for the USPSTF
- HR 539: USPSTF reform