The USPSTF is at it again. For those of you not familiar with the USPSTF it is the US Preventative Services Task Force, a panel made up of primary care doctors. They recently decided that women in their forties no longer needed mammograms. Having seen their recent opinion on PSA and being familiar with the mammogram recommendation I elected to look into just who made up this panel. The panel describes itself as an independent panel of non-federal experts composed of primary care providers. The chair is a Dr. Moyer, Professor of Pediatrics at Baylor, obviously an expert in the field of PSA and Mammograms. There are no oncologists, urologists, or surgeons involved in any way with the panel. I will elaborate on their decision and explain contrasting opinions of true experts.
PSA and the USPSTF
The USPSTF changed their position on the benefits of PSA screening from inconclusive to NO BENEFIT to men under 75 years of age. PSA screening was associated with an increase in prostate cancer detection and those men were at risk of more harm with few benefits to mortality. They felt that this has led to over diagnosis and treatment and that screening was associated with false positives leading to unnecessary biopsies. They extended their recommendation to high risk groups, including African American males and those with a family history of prostate cancer.
Dr. Carter Director of Urology at Brady Urological Institute at John Hopkins says PSA is the only screening test that we currently have and it saves lives when used correctly. His choice is to look at the PSA history in each individual and make decisions based on changes.
Dr. Lacy the President of the AUA (American Urologic Association) feels that if the task force’s recommendations are followed it will lead to more harm than good. “… when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients.”
Dr. Kapoor President of Advanced Urology Centers of New York believes if followed the task force’s recommendation will lead to thousands of needless deaths. He states that using PSA has led to a decrease in death from prostate cancer, a drop of 38% in the last 20 years.
It seems odd that the USPSTF has made a recommendation so far outside their field of expertise, with their poor reception from both the medical community and the patients the last time they ventured so far from home. I can remember when we only had acid phosphatase and digital exam to help us with the diagnosis of prostate cancer. The success rate in helping these individuals was extremely poor. We missed the majority of cancers with our digital exams and when the acid phosphatase was elevated the patient had metastatic cancer.
The PSA was introduced and at first we had difficulties with exactly how to interpret the test but over the years we have been quite successful in using it to diagnose and cure cancer of the prostate. With the PSA history and PSA acceleration we are able to look at changes in an individuals PSA and with them more accurately predict who needs and doesn’t need a biopsy.
We are now to a point that we are referring patients to Urologists with PSA levels od 2.5 and greater. The Urologist can then track the PSA and make decisions on who needs a biopsy and who doesn’t . The key here is for doctors to refer to a competent Urologist that they trust will take care of the patient, treating them as individuals, assessing their particular risks and taking a biopsy when needed.
You can follow these recommendations or take it up with the Pediatrician next time the kids have a runny nose.
See related articles.