Responses to USPSTF’s Downgrading of PSA Screening

Posted on Oct 8, 2011 | 0 comments

Frank delaRama, R.N., M.S., AOCSN, Oncology Nurse Specialist and Prostate Cancer Nurse Navigator

Recent buzz on PSA screening is up again, thanks to the U.S. Preventive Services Task Force (USPSTF) draft recommendations to be published soon, which plan to downgrade PSA screening from “I – inconclusive” to “D – no benefit” for men younger than 75.

My first gut-level feeling as a health care provider is fear that men will flat out avoid PSA screening based upon this recommendation. On the other hand, perhaps this news will uncover an opportune teaching moment, for men to have a thorough discussion with their physician about the actual pros and cons of PSA screening, as well as prostate cancer screening in general.

Many of my physician colleagues at the Palo Alto Medical Foundation (PAMF) share similar perspectives:

“PSA screening should be a discussion between patient and physician that takes into account life expectancy, family history, patient’s acceptance for more invasive testing and present health issues,” says Andrew Epstein, M.D., urologist at the Palo Alto Medical Foundation (PAMF).

David Leibowitz, M.D., FACP, medical oncologist and director of innovation/informatics at the Palo Alto Medical Foundation, states, “This is like the mammogram recommendation from the same group. It may be that not everyone should have PSA testing, but the important point is that the physician needs to talk with the patient about the benefits and risks before they even order the test. Then the physician can help him make an informed decision, with an understanding of the good and the bad possible consequences.”

The decision whether or not to have PSA Screening is clearly a complex issue, and health care providers today do not depend upon just one set of guidelines to direct prostate cancer screening.

Pauling Chang, M.D., a radiation oncologist at the Palo Alto Medical Foundation, reinforces that prostate cancer screening, “…should also be consistent with the American Cancer Society recommendations and the American Urology Association recommendations on prostate cancer screening, which differ from what the Task Force recommends.”

Ultimately, the decision to test is your own. Don’t skip the discussion.

When considering whether or not to have a PSA test (or any health related test), if you would do something differently with your care, if the result shows something critical needing follow up or even treatment, then testing is right for you. If, even with a critical result, you would not do anything differently related to a test result, then testing is less useful to you. The important thing here is to understand all the “what if’s,” with the help of your physicians and nurses, so you can figure out the “to do’s” now.

Most often in prostate cancer, the options are so diverse (even including active surveillance) that men who have PSA screening appropriately have at least one, if not several, valid “what ifs” from which to choose.

Given the USPSTF statement downgrading PSA screening, men should take this opportunity, not to simply skip the test, but to have a thorough discussion with their physician about all the issues in prostate cancer early detection.

See my recent blog posts “A PSA on PSA” and “40-45-50,” for further details on prostate cancer screening and strategies for health care decision making.

More recommendations for prostate cancer early detection and reaction to the USPSTF announcement on prostate sceenings:

TIME’s Healthland review of USPSTF recommendation & Prostate Cancer Screening

American Cancer Society Recommendations for Prostate Cancer Early Detection.�

American Urology Association Responds to New Recommendations on Prostate Cancer Screening

This blog post is contributed by Frank delaRama R.N., M.S., AOCNS,  Oncology Clinical Nurse Specialist at the Palo Alto Medical Foundation and prostate cancer nurse navigator – a role he created at PAMF in 2004, contributed to this blog post.  Frank created PAMF’s Prostate Cancer Buddy Program and is the chair of PAMF’s Cancer Patient Advisory Council. He has helped many men and their families along the cancer care journey, from diagnosis, through treatment, and into survivorship. You can follow Frank on Twitter at @fdelarama.