May 3, 2013
“Radical change” – American Urological Association stops recommending routine PSA tests
On Twitter, Liz Szabo of USA Today asks, “Is this the end of the PSA?” She was referring to new clinical guidelines released by the American Urological Association.
She reported:
“In a major break from the past, a leading medical group is advising men to think carefully before getting getting screened for prostate cancer.
The American Urological Association, which has staunchly defended the PSA screening test in recent years, says healthy men under 55 don’t need routine annual screening. And men ages 55 to 69 who are considering the PSA should consult their doctors about the test’s benefits and risks, according to a new policy announced Friday. Until now, the group had advised healthy men ages 40 and up to ask their doctors about the PSA.
Authors of the new guidelines “learned very quickly that there really was no high-level evidence supporting the use of screening with PSA,” says urologist H. Ballentine Carter, who chaired the panel that wrote the new guidelines.”
The story goes on to include quoted experts calling it “a big change” and “a radical change but a welcome one.”
Here are links to other news coverage.
One year ago, the US Preventive Services Task Force recommended against PSA-based screening for prostate cancer. That announcement drew some angry reactions from some. One wonders if the same vitriol will be leveled against the American Urological Association. While the recommendations of the two groups are still different, they overlap more now than perhaps ever before.
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Comments (12)
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Ken Leebow
May 3, 2013 at 1:33 pmThis is great news. Now, maybe my peers will not think that I am crazy when I tell them I do not get screened for the PSA. However, during my last appointment, I asked my doc not to perform the PSA. She did it anyway. Ironically, she wanted me to follow-up with a urologist. I declined the offer.
Maggie Mahar
May 5, 2013 at 11:14 pmIn the midst of so much irrationality, Reason is still alive.
We should Never give up hope.
Congratulations to the AUA!
And thanks for reporting this. HealthNewsReview is essential.
Maggie Mahar
May 5, 2013 at 11:14 pmIn the midst of so much irrationality, Reason is still alive.
We should Never give up hope.
Congratulations to the AUA!
And thanks for reporting this. HealthNewsReview is essential.
Greg Pawelski
May 6, 2013 at 9:09 amI was reminded by someone on Matt Holt’s health care blog some years ago that cancer medicine is like a large supertanker. It cannot turn on a dime, even out in the ocean. The reductionists form of behavior in this case seems to be the same.
David S. Most, PhD
May 6, 2013 at 8:25 pmThe AUA and all the other groups that deal with prostate issues caution men that over treatment of non-aggressive cancers is what leads to potentially terrible side-effects. And all agree that our ability to differentiate between the “tigers” and the “pussycats” is pretty weak. Our ability to detect extra-capsular extension early in the disease process is also weak. But asking, nay telling, men to play Russian Roulette with their well-being doesn’t make sense either.
How much time will an MD spend educating the patient? With a waiting room full of patients I don’t think he/she can provide the time. Will a non-urologist have the depth of knowledge to offer the patient?
The same breast cancer anti-screening message was delivered earlier to women . Women didn’t like that advice and continue getting mammograms.
For how many years were we conditioned to believe that “early detection” meant higher cure chances? Forgot it folks, “New analysis” has rendered that maxim as obsolete as blood-letting to cure the “vapors”.
Medicine in a free economy responds to all kinds of other non-medical pressures. Death from prostate cancer is ugly. Minimizing it is a highly desirable goal.
David S. Most, PhD
May 6, 2013 at 8:25 pmThe AUA and all the other groups that deal with prostate issues caution men that over treatment of non-aggressive cancers is what leads to potentially terrible side-effects. And all agree that our ability to differentiate between the “tigers” and the “pussycats” is pretty weak. Our ability to detect extra-capsular extension early in the disease process is also weak. But asking, nay telling, men to play Russian Roulette with their well-being doesn’t make sense either.
How much time will an MD spend educating the patient? With a waiting room full of patients I don’t think he/she can provide the time. Will a non-urologist have the depth of knowledge to offer the patient?
The same breast cancer anti-screening message was delivered earlier to women . Women didn’t like that advice and continue getting mammograms.
For how many years were we conditioned to believe that “early detection” meant higher cure chances? Forgot it folks, “New analysis” has rendered that maxim as obsolete as blood-letting to cure the “vapors”.
Medicine in a free economy responds to all kinds of other non-medical pressures. Death from prostate cancer is ugly. Minimizing it is a highly desirable goal.
Richard Hoffman
May 6, 2013 at 11:05 pmI’m in San Diego at the AUA meeting and earlier today (May 6) heard Dr. H. Ballentine Carter present the updated AUA guideline on the detection of prostate cancer to a packed auditorium. This guideline represents a remarkable evolution for the AUA. After PSA was introduced in the 1980s, the AUA jumped on the screening bandwagon (with the ACS) even though there was evidence only that PSA was more likely to detect early prostate cancer than digital rectal examination. Eventually, the AUA recognized that screening was a complex issue—with uncertain survival benefits offset by proven risks for overdiagnosis and treatment complications—and that providers needed to support patients in making informed decisions. After the major screening trials were published showing a small survival benefit for screening men between the ages of 55 and 69, the pro-screening faction in the AUA inexplicably jumped the shark by recommending in 2009 that screening be first offered to average risk men at age 40 and that biopsy referral be based on a confusing–and unproven–array of laboratory, clinical, and demographic criteria.
Since then, the Institute of Medicine issued a position paper for developing guidelines. Clearly, the AUA has taken to heart the IOM advice to use a multi-disciplinary evidence-based approach. The AUA has created a very credible guideline that aligns well with the ACS recommendations for shared decision making. However, some of the wording is confusing, particularly to those familiar with the Task Force recommendations. If the alternative to routine screening is to support shared decision making (for men ages 55 to 69), then seemingly the recommendation should be to not consider screening any average-risk men who fall outside this age range.
After the USPSTF issued a D recommendation against any PSA screening last year, the response by the AUA and prominent urologists ranged from outrage to vitriolic attacks—and support for legislation to reconfigure the Task Force by including more specialists. It will be interesting to see how these Task Force critics respond to the temperate guideline issued by their own professional society.
Richard Hoffman
May 6, 2013 at 11:05 pmI’m in San Diego at the AUA meeting and earlier today (May 6) heard Dr. H. Ballentine Carter present the updated AUA guideline on the detection of prostate cancer to a packed auditorium. This guideline represents a remarkable evolution for the AUA. After PSA was introduced in the 1980s, the AUA jumped on the screening bandwagon (with the ACS) even though there was evidence only that PSA was more likely to detect early prostate cancer than digital rectal examination. Eventually, the AUA recognized that screening was a complex issue—with uncertain survival benefits offset by proven risks for overdiagnosis and treatment complications—and that providers needed to support patients in making informed decisions. After the major screening trials were published showing a small survival benefit for screening men between the ages of 55 and 69, the pro-screening faction in the AUA inexplicably jumped the shark by recommending in 2009 that screening be first offered to average risk men at age 40 and that biopsy referral be based on a confusing–and unproven–array of laboratory, clinical, and demographic criteria.
Since then, the Institute of Medicine issued a position paper for developing guidelines. Clearly, the AUA has taken to heart the IOM advice to use a multi-disciplinary evidence-based approach. The AUA has created a very credible guideline that aligns well with the ACS recommendations for shared decision making. However, some of the wording is confusing, particularly to those familiar with the Task Force recommendations. If the alternative to routine screening is to support shared decision making (for men ages 55 to 69), then seemingly the recommendation should be to not consider screening any average-risk men who fall outside this age range.
After the USPSTF issued a D recommendation against any PSA screening last year, the response by the AUA and prominent urologists ranged from outrage to vitriolic attacks—and support for legislation to reconfigure the Task Force by including more specialists. It will be interesting to see how these Task Force critics respond to the temperate guideline issued by their own professional society.
RL Mattison
May 7, 2013 at 11:39 amWhat about the “Urine Biomarker Combo Predicts Prostate Cancer” study done in Milan, Italy. Seems that it gives a much more accurate result than PSA.
http://www.medscape.com/viewarticle/781801
RL Mattison
May 7, 2013 at 11:39 amWhat about the “Urine Biomarker Combo Predicts Prostate Cancer” study done in Milan, Italy. Seems that it gives a much more accurate result than PSA.
http://www.medscape.com/viewarticle/781801
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