The U.S. Preventive Services Task Force (USPSTF) published their final recommendation on PSA testing in an Annals of Internal Medicine article this week. The panel advises against PSA-based prostate cancer screening for men of all ages. The rationale for this recommendation is based on the panel’s moderate certainty that the potential harms outweigh the benefits for all age groups. Based on clinical evidence from two large randomized trials evaluated by the panel, at most 1 out of 1,000 men screened will avoid dying from prostate cancer over 10 years, while many more men will be left with permanent disabilities from their treatment, such as incontinence (18 in 1,000) or impotence (29 in 1,000).
The rationale for decision aids is addressed in the accompanying paper. Unlike hormone replacement therapy, prostate surgery is a "Rubicon" procedure -- that is, once undertaken it cannot be reversed. In the United States, a pilot study on the impact of a programme to aid in decisions about benign prostatic hyperplasia showed a 40% decrease in surgery rates. This finding was not replicated in a subsequent randomised controlled trial.
Posted in Patient Decision Aids, Patient Involvement, Special Populations
Tagged Angela Coulter, benign prostatic hyperplasia, BMJ, BPH, decision aids, decision-making, men, multimedia, primary care, prostatectomy, Shared Decision-Making® programs, treatment decisions