LINTHICUM, MD—In response to specific questions outlined by the U.S. Preventive Services Task Force (USPSTF), a coalition of physicians and patient groups provided comments in response to a call for feedback on the USPSTF’s Draft Research Plan for Prostate Cancer: Screening. The research plan, once finalized, will guide the Task Force’s development of new recommendations on prostate cancer screening. The new recommendations, according to the USPSTF website, are slated to be released in 2017.
Among the common themes outlined in the comments were an increased emphasis on high-risk populations, the inclusion of data on the harms of not screening for prostate cancer, and a call for inclusion of specialists in the development of recommendations. The groups also addressed a number of issues, including the importance of maintaining the distinction between prostate cancer screening tests (such as prostate-specific antigen, or PSA) and other diagnostic tests that may or may not follow (biopsies, etc.). Other areas of concern include:
Harms of screening vs. harms of not screening: The USPSTF draft research plan outlines a focus on the harms of PSA-based screening for prostate cancer, but does not reference the potential harms of not screening for this disease. It was the consensus of the coalition that, if the outcomes and harms of testing are to be considered, then the panel must also take into account the harms associated with not screening (e.g., late diagnosis, advanced disease) when reviewing the literature.
Appropriate testing in high-risk populations: The USPSTF needs to consider as part of its evidence review the nuances associated with screening in high-risk populations (e.g., men with a family history of disease, African American men) and thoroughly assess the benefits and harms of PSA screening in these men. Recommendations for screening in men with elevated risk factors should be made using a risk-categorized approach, and based upon available evidence for each risk category.
Inclusion of additional screening tests for prostate cancer, increases in active surveillance following diagnosis: In recent years, a number of new screening tests have become available for use, including blood- and urine-based prostate cancer biomarkers. In addition, imaging is also an important tool that should be reviewed for utility in conjunction with PSA testing. The USPSTF needs to also review the role that active surveillance plays in monitoring men with diagnosed prostate cancer that may not require active treatment immediately. These tools have the potential to reduce harms related to over-diagnosis while simultaneously allowing physicians to monitor patients with known disease. This approach will also preserve the benefit of screening in men at higher risk for developing prostate cancer.
Other overall observations and comments centered on the potential impacts of the current recommendations and a call for the inclusion of specialists in the development process. For instance, while the current “D” rating given to prostate cancer screening by the USPSTF does not mean that men cannot get tested for prostate cancer, recent literature has shown that testing rates have declined since the USPSTF released its recommendations in 2012. The “D” rating also has the potential to negatively impact coverage for this test in men, regardless of their risk.
Groups also felt strongly that involving specialty physicians (e.g., urologists, oncologists, etc.) in the recommendation development process would be beneficial. The USPSTF’s current recommendations on prostate-specific antigen (PSA) testing were issued in 2012 and run contrary to the positions of many leading medical societies that advocate for discussion about the benefits and risks of PSA screening in targeted populations, including the American College of Physicians, the American Society of Clinical Oncology, the American Cancer Society, the National Comprehensive Cancer Network and the American Urological Association.
The coalition includes a number of high profile patient organizations, including Men’s Health Network, the National Alliance of State Prostate Cancer Coalitions, the Prostate Conditions Education Council, the Prostate Cancer Foundation, the Prostate Health Education Network (PHEN), UsTOO International Prostate Cancer Education and Support Network and ZERO – The End of Prostate Cancer. In addition to patient advocacy groups, the American Association of Clinical Urologists, the American Urological Association and the Large Urology Group Practice Association (LUGPA), who collectively represent virtually all the nation’s urologists, are members of the coalition and submitted formal comments on the USPSTF document.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 20,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.
Wendy Waldsachs Isett, AUA