The US Preventive Services Task Force is as fickle an organization as can be found in medicine. Consider their position about prostate cancer it seems to change more often than an infant’s diaper. Their latest pronunciamento on the subject is summarized below. Their full statement is at the end of this piece. Part of the reason the task force is so changeable is medical politics. A lot of special interest groups like urologists and oncologists don’t like the advice to forgo PSA testing and pressure the task force to ease up a bit, which they do. Of course, new data require more nuance.
It (the latest recommendation) takes the revolutionary stance that doctors should talk to their patients before they offer a service which may be of limited value and which can also lead to serious complications. Talking to patients about a complex issue takes time which physicians have less and less of as the need to move them (the patients) along increases.
It should not take a recommendation from a task force to get doctors to discuss important issues with those for whom they care. Ever since PSA testing first came along it was obvious to any physician that such screening was a complicated issue that required thought by doctors and understanding by those who would be subjected to it. Finally, note that the task force still advises against PSA screening in men 70 and older – a cohort that is still likely to get the test, often without any discussion before it’s done.
For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)–based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.
