United States Preventative Task Force creates controversy around PSA Screening. Dr. Patel responds!
"At 1:30 pm on May 22nd 2012 in front of over 1,000 medical professionals, Dr. Timothy Wilt, professor of Medicine at the University of Minnesota, delivered a blow that could serve as a death sentence for hundreds of thousands of men worldwide.
Dr. Wilt spoke at the annual meeting of the American Urological Association delivering the judgment of the United States Preventative Task Force (USPSTF). The decision was that the USPSTF did not advocate the use of Prostate Specific Antigen (PSA) for screening of men for prostate cancer."
Controversy has ensued as the urologic community expresses its outrage towards the final recommendations of the USPSTF. The Task Force discouraged the use of PSA testing, declaring with certainty that "the harms outweigh the benefits". The American Urological Association (AUA) is in strong opposition of this decision and continues to support the use of the PSA test as it is the only widely available test for prostate cancer.
The International Prostate Cancer Foundation is in agreement with the AUA, believing that with proper interpretation the test provides critical information in the diagnosis, treatment, assessment and monitoring of prostate cancer patients and those at risk.
Over 30,000 men die from prostate cancer each year and physicians are now concerned that with such news this number will only increase. Screening and detection are instrumental in overcoming mortality, with survival rates at over 90% upon early diagnosis and treatment. The disease strikes 1 in 6 men in their lifetime and the outcome is fatal for 1 in 36 men in the U.S. Prevention is historically dependent upon consistent testing practices. It is clear that deeming PSA screening as unnecessary only complicates the battle against prostate cancer.
WHAT IS PSA SCREENING:
The PSA screen is a simple blood test that helps diagnose prostate cancer by assessing the levels of Prostate-Specific Antigen in men. PSA is a key marker of many prostate diseases. Advocates often suggest combining PSA screening with a digital rectal exam (DRE) for the most accurate result. With this information physicians can make informed decisions regarding further medical recommendations and provide thoughtful and thorough patient care.
As a respected expert in this field, Dr. Patel was asked to present his position on the issue and his FULL response is as follows:
The International Prostate Cancer Foundation is an organization dedicated to the prevention and cure of prostate cancer. We are a not-for-profit organization led by global medical experts in the field of prostate cancer and by patients dedicated to the cause. We strongly oppose the decision of the United States Preventative Services Task Force (USPSTF) in revoking the use of Prostate Specific Antigen (PSA) testing in men. This is the reason why we are creating a petition to ask the Task Force to reconsider their position.
PSA has been used for routine screening and the detection of prostate cancer since the early 1990s. It is a simple blood based test that is ordered for men age 40 and over as part of routine blood work on an annual basis.
Since its inception, the death rate from prostate cancer has reduced consistently every year.
In the United States, approximately 240,000 men are diagnosed annually with the disease and approximately 40,000 die from it. Prostate cancer represents the most commonly diagnosed solid organ tumor in men and the second most lethal cause of death.
Prior to the inception of PSA, the death rate from prostate cancer was much higher with the majority of men being diagnosed with advanced stages of the disease. The use of widespread PSA screening has reduced cancer specific mortality rates.
The decision of the USPSTF will echo around the world to men and their families as undoubtedly more will die from the disease. The USPSTF’s goal was to examine the use of PSA as a screening test and its ability to reduce disease specific mortality. The Task Force evaluated many large studies but focused on two: the PLCO and ERTSP.
The PLCO is a US-based study consisting of less than 40,000 men. It evaluated cancer-specific survival from prostate cancer in two groups of men: those who were screened with PSA testing and those who were not.
However, the study was flawed in several ways. The control arm of the study was contaminated because more than 50% of the non-screened arm actually got PSA screenings, therefore completely negating the study’s validity.
In addition, the study’s follow-up period was only 7 years, a relatively short time frame for a study of this magnitude. The study concluded that there was no difference in prostate-specific survival in those being screened with PSA from those who were not screened.
Measuring short-term in medicine is akin to canceling a baseball game in the 5th inning of a 2-1 game with the result thought to be inevitable. Many men are currently diagnosed via PSA screening in their 40’s, 50’s and 60’s with decades to live. The use of a short-term 7-year study inaccurately evaluates their lifetime risk of death. Many scientists reject the validity of the PLCO study because of the screening contamination and short follow-up.
Prostate cancer is a slowly-progressive disease and very few men die in the short- term from prostate cancer. Nevertheless, it can progress to a higher stage and become incurable during that time by experiencing metastasis and resulting in death in the long term.
The USPSTF’s research overlooked the results of the ERSPC study of PSA screening that had a longer follow-up period and a favorable finding for the PSA screening. The USPSTF also avoided a much-quoted Scandinavian study, the largest population-based study ever undertaken for PSA screening in men, which also showed a significant advantage to prostate cancer treatment.
This is the same Task Force who, just a few years ago, concluded that mammograms were unnecessary in screening women for breast cancer and later rescinded their conclusions. They have now set their sights on men with prostate cancer. This final supposition comes from a group that included no urologist or medical professional that specializes in the care of prostate cancer patients. Prostate cancer is a severe disease that has the second-highest mortality rate in men; consequently, the decision to prevent PSA screening in men will surely raise the death rate to number one.
The International Prostate Cancer Foundation feels that the decision of the Task Force is premature and based on flawed short-term studies that were poorly conducted. Prostate cancer-specific mortality has dropped 40 percent in the last 20 years since inception of PSA-based screening.
The D rating provided by the USPSTF for PSA-based screening will result in fewer men being diagnosed early with curable prostate cancer and more men presenting with advanced stages of the disease.
We believe it is irresponsible to provide such a blanket recommendation that ignores at-risk populations, such as men diagnosed at a young age with a life expectancy of over 10 years, men with family history of prostate cancer and African-American males. African-American males are at greater risk of getting prostate cancer at a younger age and dying from the disease.
We at the International Prostate Cancer Foundation object to this on behalf of all families globally as it deprives men of their right to know that they have prostate cancer and of the right to make decisions about their own health. We encourage all to join our campaign by signing our petition to have the USPSTF reconsider their stance on the life-saving PSA test. Please visit the following to read our petition USPSTF: Withdraw PSA Decision and add your name to the list. You may also help us spread awareness about the importance of PSA testing by making a donation to the International Prostate Cancer Foundation.
Vipul Patel, MD FACS
Founder, International Prostate Cancer Foundation