Tuesday, April 11, 2017

The USPSTF takes a step backward on PSA screening

I don't agree with all of the statistics cited in this infographic, particularly the optimistic estimate that 1-2 men out of every 1000 screened with the PSA test avoid death from prostate cancer. I believe that the USPSTF's 2012 estimate of 0-1 men remains more accurate, but even if the new figure is true, I don't think that changing the PSA recommendation from a "D" (benefits no greater than harms, don't do) to a "C" (small net benefit, do selectively) is warranted, given the collateral damage to men's health that screening produces. In an editorial in JAMA, the USPSTF Chair and Vice-Chairs have invited the public to comment on the draft recommendations, which are more consistent with those from the American Cancer Society and American Urological Association than the American Academy of Family Physicians and the American College of Preventive Medicine (which both recommend against PSA-based screening). They will hear from me, and I hope that they will hear from others in primary care about the physical, psychological, and opportunity costs of taking a step backward on PSA screening.