PCSANM applauds the newly-published guidelines of the USPSTF on prostate cancer screening for being a good start. There is much to be said for the fact that the task force paid attention to dissatisfaction with the prior 2012 guidelines. We also applaud the task force’s emphasis on the importance of shared and informed decision making in testing for prostate cancer.

However, while PCSANM is pleased with the “C” recommendation embodied in the guidelines, there are weaknesses and omissions. Why a “C” but only for men 55-69? Just because the retrospective studies to date have looked more at that age group than others ignores the fact that because prostate cancer is often slow-growing, one doesn’t see the benefits of screening sometimes for more than 10-15 years. Screening early means fewer chances of developing metastatic disease during those years, so why wait until 55 to start testing? We believe that a man’s first, baseline PSA should be around the age of 45, establishing risk and personalizing future follow up. That risk stratification is critical. PSA is just a data point; it is what you do with that information that is important. 

Why does the USPSTF (that worries about over treatment if a man is diagnosed) not recommend genomic testing, MRI, liquid biopsies, and other indolent disease that might lead to active surveillance rather than treatment? Why stop testing at age 70 and classify that as a “D” recommendation? Both the American Cancer Society and National Comprehensive Cancer Network talk about testing for men with at least a ten-year life expectancy– that should be the criterion, not an arbitrary age marker. And veterans, especially those who were exposed to Agent Orange, should be included in the “higher risk” population for earlier testing, along with African-American men and men with a positive family history.