Urologists Condemn Task Force's Anti-PSA Testing Stance
William J. Catalona, MD
ATLANTA—The U.S. Preventive Services Task Force (USPSTF) on May 21 released its final recommendations on PSA-based screening for prostate cancer (PCa), which advises against the practice and gives it a grade D rating, meaning the task force believes there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefit.”
Although some men may benefit from having PCa detected early through PSA screening, the task force contends there is no conclusive evidence that routine PSA screening save lives, and noted that false-positive PSA test results can cause psychological harm and lead to prostate biopsies, which can cause discomfort.
Moreover, testing can lead to treatment of cancers than may never cause any problems, according to the task force. These treatments frequently are associated with erectile dysfunction, urinary incontinence, bowel dysfunction, and death.
“A proportion of those treated, and possibly harmed, would never have developed cancer symptoms during their lifetime,” the task force wrote.
The American Urological Association (AUA), which is holding its annual meeting here, condemned the task force's position. At a press conference organized by the AUA the same day, John H. Lynch, MD, a member of the AUA board of directors and Chief of Urology at Georgetown University in Washington, D.C., asserted, “It is a disservice to men to deny them the opportunity for potential treatment and cure when necessary for a disease that affects one in six men over the course of their lifetime.”
David F. Penson, MD, Professor of Urologic Surgery at Vanderbilt University in Nashville, Tenn., and the incoming chair of the AUA's Health Policy Committee, noted that the AUA, the American Cancer Society, and other medical groups believe that men should talk with their doctors about their individual prostate cancer risk, with PSA testing an individualized decision that should happen in the context of that discussion. “By giving the test a D rating, the USPSTF has effectively stated that primary care physicians should not have a balanced discussion with the patient,” Dr. Penson said.
William Catalona, MD, Professor of Urology at Northwestern University in Chicago and a pioneer in the development of the PSA test, also voiced opposition to the task force guidelines.
“The main goal of early detection and screening programs is to allow a person to avoid a particularly unpleasant death, such as a death from prostate cancer,” Dr. Catalona said. “There's strong evidence that PSA testing substantially reduces prostate cancer death.”
Since the introduction of PSA screening in the United States, the PCa death rate has decreased by more than 40% and the percentage of men who have distant metastases and incurable disease at the time of diagnosis has decreased by 75%. In addition, he noted that statistical teams at the National Institute of Health concluded that up to 70% of these results are attributable directly to PSA testing.
“We think that men should be made aware and offered an opportunity to make an informed decision for themselves,” Dr. Catalona said. “The PSA test provides very powerful predictive information about a man's risk for prostate cancer.”