Prostate Screening Remains A Crucial Step Despite What Task Force Says

By Dr. Scott Owens

As a practicing urologist for the last 18 years focused on treating men with prostate cancer, I was alarmed by the final recommendation of the U.S. Preventive Services Task Force that healthy men should no longer receive prostate specific antigen testing.

Prostate cancer screenings are still key to early detection.

What is truly shocking is that this recommendation was made without a single urologist or oncologist serving on the task force. Had the task force bothered to have a specialist in the field, it might have seen the study published this spring in the New England Journal of Medicine that once again reaffirmed that prostate screening saves lives.

The article was based on an update to the European Randomized Study for the Screening of Prostate Cancer. There is much to criticize in the task force recommendation, but my main purpose for writing is to clarify the facts for our community, for survivors of prostate cancer, and, most importantly, for those men at highest risk for prostate cancer — African-American men and men with a family history of prostate cancer.

The recommendation against PSA screening hits close to home in Pennsylvania. The American Cancer Society estimates that in 2012 there will be 11,890 new cases of prostate cancer diagnosed in our state (the fifth-highest total in the country), and 1,330 Pennsylvania men will die from the disease (the sixth highest total in the country).

The disease hits with particular force in the African-American community, with the state Department of Health having reported that the number of new prostate cancer cases is 67 percent higher among African-American men than white men.

I write not only based on my own experience diagnosing and treating men with prostate cancer for the last two decades, but on behalf of Urologists for Patient Access to Care, a coalition of nearly 100 urologists who diagnose and treat one out of every four men diagnosed with this disease in our state.

We are united in our opposition to the task force recommendation, and we appreciate the leadership and foresight of the members of our state House of Representatives, which unanimously passed a resolution last month memorializing the U.S. Congress to seek the withdrawal of the task force’s then-draft recommendation against PSA screening.

Despite the fact that deaths from prostate cancer are still too high, we have witnessed a nearly 40 percent reduction in prostate cancer mortality since the introduction of PSA testing two decades ago. It’s clearly been shown that early treatment of moderate-aggressive prostate cancer can save lives.

For the task force to recommend against PSA screening in asymptomatic men makes utterly no sense, given that in its localized form prostate cancer produces no symptoms in the majority of men. By the time symptoms manifest themselves, it is often too late to treat and cure the disease.

The PSA blood test is the only available laboratory study we have at our disposal to detect the disease in asymptomatic men. By eliminating PSA testing, we eliminate the initial phase of detection and set up a scenario in which men will now visit our office with more advanced disease, including metastatic cancer.
The clinical value of the PSA blood test was just again validated in the European study. The authors found a 21 percent overall survival advantage and 38 percent reduction in mortality in men followed for more than 10 years.

By ignoring the science and comments from the urologic and oncologic communities, the task force has truly done a disservice to survivors, family members and the 28,000 men nationwide who die each year from this disease. In the urologic community, we have been constantly improving our clinical approach to this devastating disease.

We’ve introduced “active surveillance” protocols for nonaggressive disease. We’ve reduced our treatment complications with the introduction of robotic surgery to our armamentarium as well as image guided radiation therapy. We critically review our data, outcomes and patient surveys to maximize our patients’ experience.

As clinicians, we are focused and determined to practice “evidence-based medicine,” but when the evidence is flawed, the recommendation is flawed. When the evidence is collected in a retrospective fashion by nonurologic / oncologic clinicians the outcomes might be devastating.

The conversation our country should be having is how best to diagnose prostate cancer at an early stage and manage the subset of patients whose disease is potentially aggressive. The recommendations and standards should be developed by those clinicians who understand prostate cancer’s complexity and not by a government panel that regurgitates data from inherently flawed studies.

Dr. Scott Owens serves on the board of directors of Urologists for Patient Access to Care. He also serves on the board of directors of Urology of Central Pennsylvania and practices in Harrisburg.

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