PCSANM's Position on US Preventative Services Task Force Revised Guideline on Prostate Cancer Screening
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.

US Preventative Services Task Force (USPSTF) Revised Guideline on Prostate Cancer Screening
For men ages 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; over diagnosis and over treatment; and treatment complications such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.
US Preventive Services Task Force "C" Grade for Prostate Cancer Testing
The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.

Offer or provide this service for selected patients depending on individual circumstances.

PSA Test

Beleaguered but still useful