Originally published 6/29/2016
Less than a year after we posted the blog below, in April 2017 the U.S. Preventive Services Task Force (USPSTF) issued a draft reversal of its 2012 recommendation against broad PSA testing to screen for prostate cancer (PCa). The switch from grade D to grade C was finalized in 2018—though PSA blood tests for those ages 70+ was recommended against.
A 2021 JAMA Oncology article tracks the outcome of the upgrade, and reveals a definite rise in PSA testing in the U.S.[i] Their analysis produced the following statistics:
- The relative increase in PSA testing from 2016-19 was 10.1% for men ages 40-54, 12.1% for men ages 55-69, and 16.2% for men ages 70-89.
- PSA testing among all age groups showed an increasing trend after April, 2017—the time of the USPSTF draft reversal.
The article’s authors note, “By identifying appreciable early increases in PSA testing rates, this work can directly inform estimates of the outcome of the USPSTF statement change, signaling a reversal in early detection practices.” At the Sperling Prostate Center, we believe that there were many factors that influenced the official 2018 upgrade for PSA testing, among which were grass roots efforts from patient advocacy groups in addition to academic and professional pressures. We also believe that the growing availability of mpMRI as an intermediate step between a suspicious blood test and a needle biopsy has helped to reduce the number of unnecessary biopsies (with all their risks), thus removing the objection that PSA testing leads to overdiagnosis and overtreatment. We are proud that our own blogs have repeatedly reinforced the value of PSA screening, now that mpMRI removes the fear that “tests beget more tests.”
Near the end of 2015, CMS (Centers for Medicare and Medicaid Services) proposed a measure that would penalize doctors who ordered PSA tests. It would be an economic penalty, in some form of a fine. Aside from being a harsh measure, it would reinforce a trend already noted in published studies: since the US Preventive Services Task Force (USPSTF) recommended against PSA screening for prostate cancer (PCa), there is an increase in patients being diagnosed with higher Gleason scores and bulkier disease because they weren’t screened. A new study reveals early but compelling evidence that the reduction in PSA screening starting in 2013 is already leading to an increase in diagnosing men with bulkier and more aggressive PCa because they weren’t screened earlier.
CMS has backed down from the proposal, thank goodness. Much credit for this goes to a coalition of PCa patient advocacy organizations. The coalition is called PCPC3, which stands for the Patient-Centered Prostate Cancer Coalition. You may recognize one or more of the current member organizations:
- National Alliance of State Prostate Cancer Coalitions (NASPCC)
- Prostate Advocates Aiding Choices in Treatments (PAACT)
- Prostate Cancer International (PCaI)
- Prostate Conditions Education Council (PCEC)
- Prostate Health Education Network (PHEN)
- Us TOO International
All of the above groups, with the exception of PAACT, issued detailed formal statements of opposition. They joined their “patient power” with that of the American Urological Association to point out the potential harm involved with depriving men of a simple and inexpensive test. No one doubts that PSA is imperfect as a PCa biomarker, or that it has led to much overdiagnosis and overtreatment. But until a better biomarker comes along (and until men with suspicious PSA results routinely have access to noninvasive 3T multiparametric MRI before biopsy) the data shows us the consequences of halting broad screening: men being diagnosed when it may be too late for a local cure.
It is inspiring when collective action brings a poorly informed policy movement grinding to a halt. In fact, the USPSTF is taking a second look at its 2012 recommendation against PSA screening. PCPC3 has issued a statement that they are pleased by the withdrawal of the penalty proposal, and they appreciate the work of the USPSTF to revisit their original determination. My own feeling is that the researchers who began tracking the impact of reduced screening starting in 2013 brought to light a situation that needs to be reversed as soon as possible, and the power of grassroots influence brilliantly reinforced the message.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Leapman MS, Wang R, Park H, et al. Changes in Prostate-Specific Antigen Testing Relative to the Revised US Preventive Services Task Force Recommendation on Prostate Cancer Screening. JAMA Oncol. Published online November 11, 2021. doi:10.1001/jamaoncol.2021.5143