September is Prostate Cancer Awareness Month, and for a decade, our government has minimized awareness of the point that men are dying at increasing rates from this disease. This issue was excellently highlighted in a recent JAMA study, which was covered by Renal & Urology News, demonstrating that PSA screening is associated with decreased risk of death from prostate cancer. Like several studies over the last decade, these findings also indicate that more frequent screening is particularly important to the lives of Black men.
Prostate Cancer Awareness Month 2022 marks a notable milestone. It has been 10 years since the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening for all men in 2012. The subsequent decade has only strengthened my stance on this decision by the USPSTF. The decision to deprioritize PSA screenings was based on an erroneous assessment of past data and undermines the importance of shared decision making among physicians and patients.
Over the past decade, there has been a profound increase in diagnoses of metastatic prostate cancer, and this trend has been repeatedly demonstrated by multiple researchers. There remain a few outlets that would debate the merits of PSA screening based on the potential of unnecessary treatment. However, one fact is indisputable—prostate cancer continues to be a serious threat, and it is a growing threat. It is the second leading cause of cancer death in American men, and doctors are more often discovering advanced prostate cancer when the patient first presents.
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Earlier in 2022, the Biden Administration relaunched the Cancer Moonshot project, which partially aims to diagnose cancer earlier through increased access to screenings and a particular focus on inequities in cancer care. Where is that moonshot for prostate cancer? It is not even on the launch pad. Black men in the United States are twice as likely as men of other racial and ethnic groups to die from prostate cancer — the widest racial disparity of any cancer.
To help achieve the Cancer Moonshot’s goal, LUGPA, the only urology trade association in the United States, implores the USPSTF to reconsider its current guidelines on PSA screening. Today, the USPSTF deprioritizes PSA testing, which is given a C grade. By increasing this grade to a B or higher, more physicians will counsel patients based on the personal risk for prostate cancer and the patient’s personal preferences. Patients most at risk of prostate cancer include Black men, those with a family history of the disease and those exposed to certain toxins in the workplace or military.
On a larger scale, federal and state governments, payers and the health care community must continue to explore solutions that can reduce socioeconomic barriers to screening, such as waving cost sharing for at-risk patients. The road to progress is long and complex—but what concerns me most is that the evidence proves we are traveling in the wrong direction.
Jonathan Henderson, MD, is president of the Large Urology Group Practice Association.
