Dr. David Samadi gives his expert opinion on the US Preventative Services Task Force 2017 Draft Recommendation Statement on screening for prostate cancer based on an updated systematic evidence review and assessment.
In 2012, the US Preventative Services Task Force (USPSTF) came out with a recommendation statement finding based on research evidence that the benefits of screening did not outweigh the harms and assigned it a D grade, recommending against routine PSA-based screening for prostate cancer in all men. Now, five years later, the USPSTF 2017 through a systematic review of the evidence has determined that the potential benefits and harms of prostate specific antigen (PSA)-based screening are closely balanced in men ages 55 to 69 and to allow each individual man to make the determination whether to be screened or not. This new recommendation is based on physicians discussing with men ages 55 to 69 about the potential benefits and harms of screening, making this a C recommendation instead of a D recommendation.
“I believe this is a positive step in the right direction and I’m happy to see that the USPSTF does recognize the importance of PSA screening for men,” stated Dr. Samadi. “PSA screening does save lives by catching prostate cancer at an early, more treatable stage. Another important benefit from PSA screening is in helping the reduction of the risk of metastatic cancer in which the cancer has spread beyond the prostate to other areas of the body making it more difficult to cure.”
This new recommendation still advises that men ages 70 and older should not be screened for prostate cancer as the potential benefit of PSA-based screening does not outweigh the potential harm which is a D recommendation.
“This new draft applies to men who have no signs or symptoms of prostate cancer or have ever been diagnosed with the disease. It also applies to men at average risk and to African American men or men with a family history of prostate cancer,” explained Dr. Samadi. “As a urologist, I know the importance of discussing with African American men or men with a family history about providing them with the information they need supporting them in making decisions on being screened.”
What prompted the USPSTF to upgrade its recommendation was based on three things: One was additional evidence published since the 2012 recommendation statement. Follow-up of the largest trial showed a benefit of prostate cancer screening showing a reduction in prostate cancer mortality of slightly more than 1 man per 1000 who were offered screening who avoided death from prostate cancer. Also new evidence that 3 men per 1000 offered screening could possibly avoid metastatic disease.
“A second reason was due to the fact that the balance of benefits and harms in men remain very close, said Dr. Samadi. “It really boils down to how much value does a man place on the benefits of PSA screening versus the harms. Some men will be more willing to risk the possible harms of PSA screening that might lead to over-diagnosis or incontinence while other men place value on reducing their chance of dying from the disease or the chance of it spreading by getting a PSA screening.”
Thirdly, men who are disproportionately affected by prostate cancer – African American men and men with a family history and often underreported in the prostate cancer research – were given more attention to their particular needs. Even though there is not enough evidence to make a specific recommendation of these two groups of men at this time, the USPSTF did emphasize the need for more studies in these populations.
“Active surveillance also played a role in the USPSTF decision on upgrading its draft recommendation,” stated Dr. Samadi. “Active surveillance is becoming a more common treatment choice for men who have low-risk prostate cancer. When a man chooses active surveillance, this may be able to reduce the risk of overtreatment in addition to delaying active treatment and thus complications possibly associated with that.”
Since this is a draft recommendation, the USPSTF welcomes comments from individuals and organizations that can be submitted directly on the USPSTF website. Dr. Samadi does encourage anyone to provide their input which can help the USPSTF to make its final recommendation statement.
“The decision to whether to begin PSA screening is not always easy for men. Prostate cancer is one of the most common cancer affecting men and ultimately, men deserve and need to make the best and right choice for them on an individual basis,” advised Dr. Samadi. “I’m here to work with men to sort through the facts guiding them on their decision they feel most comfortable with and that I do too.”
Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi. For a free phone consultation and to learn more about prostate cancer risk, call 212-365-5000.