In May, the United States Preventative Service Task Force (USPSTF) made its final recommendation discouraging men from receiving prostate-specific antigen (PSA) testing as part of routine prostate cancer screening.
The urological community and I strongly oppose the USPSTF recommendations because the panel’s analysis is fundamentally incorrect, emphasizing a single flawed study while dismissing epidemiological and scientific data that supports the benefits of PSA screening for prostate cancer. As the USPSTF is not required to hold meetings in public; consider public comments; nor disclose its methodology, we can’t even ask how they arrived at this misguided and dangerous conclusion.
Prostate cancer is the most common non-skin cancer affecting men in the U.S. and the second leading cause of cancer-related deaths in men. In fact, one in six men will be diagnosed with prostate cancer during his lifetime and despite advances in early detection and treatment, one man dies every 30 minutes from this disease. The panel’s one size fits all recommendation puts into harm’s way those at greatest risk for this disease, those with a family history of prostate cancer and African-American men (for whom the death rate from this disease is more than double for Caucasians).
Since there are no symptoms of early prostate cancer, the only way to detect prostate cancer is with early screening. Opponents of screening suggest that we are detecting more and more cancers when in fact, the incidence of prostate cancer has decreased slightly over the last 20 years. Prior to PSA screening, the 10-year survival from prostate cancer was 53.6%; after screening this has increased to an astounding 98.6%! We are not detecting more cancer, we are detecting cancer earlier and saving lives.
The largest study on prostate cancer screening, the European Randomised Screening for Prostate Cancer study (ERSPC) recently published its updated findings on over 160,000 patients. They found that there was as much as a 21% survival advantage in men who received screening vs. those that had not. Earlier this month, researchers from the University of Rochester published information in the journal Cancer that found that without PSA screening in the United States, more than three times as many men would present with advanced (and incurable) disease. If these recommendations are not reversed, we will have a public health catastrophe in 5-10 years.
It is truly frightening that the USPSTF panel, chaired by a pediatrician, without a member that has ever treated a single patient with prostate cancer, continues to disregard the views of experts in the field and patient advocacy groups in making this recommendation. This inexperience is reflected in the fact that the USPSTF confuses the risk of screening (which is a simple blood test and brief examination) with treatment. In fact, screening is not treatment, it is not even diagnosis. Screening simply provides information that permits men to make better informed health care decisions; no unaccountable government entity should have the power to deny men that right.
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