How the USPSTF 2012 Decision to Discourage Prostate Cancer Screenings Has Been Detrimental to Men’s Health
As of April 2017, the U.S. Preventative Services Task Force (USPSTF) reversed its 2012 recommendation to change prostate cancer screening from a D grade (meaning to discourage use of testing) to a C grade or screening based on history and circumstances, in order to improve the screening of men ages 55-69. The task force still does not recommend screening for men age 70 and up.
The USPSTF is an independent group of 16 volunteer experts, most of who are practicing clinicians in the fields of preventive medicine and primary care, who make recommendations regarding the practice of medicine based on research and clinical evidence in order to guide the prescription of preventive medications, counseling services, and health screenings protocols.
The 2012 recommendation was reversed based on new evidence that secondary or metastatic cancers occurring in younger men who typically have more aggressive prostate cancer with early onset, are much more difficult to treat and were not being caught due to a lack of prostate screening and subsequent consideration of tumor migration. Prostate cancer is typically asymptomatic until late stage. In cases of younger patients and more aggressive cancer screening could be a life-saver if caught and treated. New research finds that 3 men in 1000 offered screening may avoid metastatic disease.
In fact, in 2011 researchers at the University of Colorado and University of Michigan have questioned the U.S. advisory panel’s breast cancer screening guidelines and suggested the panel ignored scientific evidence that more frequent mammograms save lives.
Many urologists predicted just such results after the announcement of the 2012 recommendation. They also felt the recommendation did not take into account a higher incidence of prostate cancer in African-American men, 3:1 over Caucasian men, or men with a strong family history of prostate cancer. Therefore they strongly recommended individualized consideration with regard to screening.
To this end, The American Urological Association (AUA) and ACS (American Cancer Society) have been working together on a more rational approach to screening since the idea of no screening till age 55 would miss potentially aggressive cancers in younger men. Prostate cancer of low, moderate and aggressive risk in young men could be missed and if not screened then they would have metastases and die. If caught in time, while there was still the potential risk of urinary incontinence or sexual dysfunction, those surgical risks did not outweigh that of premature death from either the primary prostate or secondary metastatic cancers. New robotic surgical procedures also improve outcomes with regards to complications such as impotence or incontinence and therefore improve post treatment quality of life.
The new data, published in JAMA begs the question: how many men may have been harmed or have died due to lack of screening since the USPSTF recommendation was instituted? Obviously better screening will now mean fewer premature deaths due to lack of screening and under-diagnosis.