On May 8, 2018, the U.S. Preventive Services Task Force made its final recommendation regarding PSA-based screening for prostate cancer: "The Task Force recommends men ages 55 to 69 make an individual decision about prostate cancer screening with their clinician. The Task Force recommends against routine screening for men age 70 and older."
Greater Boston Urology takes issue with the Task Force's final recommendation. Dr. Michael J. Curran, CEO of Greater Boston Urology, explains why in the statement below.
As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.
[Editor's note: This article was reviewed and updated on 9/20/21.]
First, we take issue with the Task Force's process. It's important to keep in mind that the Task Force is a federally funded regulatory body, yet there's no congressional oversight. So that means that this group of physicians can come out and say anything they want; there's no real recourse or ability to check them if they have a position that's contrary to what another group of physicians (such as a group of urologists) may believe.
LUGPA (Large Urology Group Practice Organization) is working to pass legislation that will provide transparency to the process by which the Task Force comes to make decisions. At GBU, we believe this oversight is needed, since the Task Force is the same group of people critical of other important cancer screenings, such as mammograms.
The second problem: the Task Force doesn't have any urologists or oncologists to study the decision-making process. The physicians on the Task Force who are making the decision don't deal with these patients or these medical conditions on a regular basis like a urologist or oncologist would.
That said, we do think the Task Force's statement is an improvement on its 2012 position. They've moved somewhat in the right direction. But they still fail to accept the fact that since their 2012 position came out, we have seen an increase in the number of deaths due to prostate cancer, and—just as important—we have seen an increase in the number of patients today who are being diagnosed with metastatic prostate cancer.
Metastatic prostate cancer is an incurable condition and incredibly expensive to treat. The Task Force's position does not take into account how many cases of metastatic prostate cancer were prevented by PSA testing.
The fact of the matter is the PSA test works really well. Routine PSA testing ramped up in the early 90s. Thanks to the screening, we got the number of prostate cancer deaths down to very low levels, which they didn't used to be. Since the Task Force's recommendation in 2012 against PSA testing (a recommendation based on two conflicting studies, one of which has been reanalyzed), prostate cancer deaths have gone up.
We wish the Task Force had taken a more open-minded position and had a more transparent process where more stakeholders could have given their opinion.
We do agree with the Task Force's statement that PSA testing should be an individual choice and that patients should discuss it with their physicians.
To that end, the doctors at Greater Boston Urology welcome patients seeking advice regarding PSA testing. You can schedule an appointment here.