Decision aids are important tools in ensuring patients understand the medical choices they face. Our decision aid "Is a PSA Test Right for You?", takes a look at the same medical evidence that the U.S. Preventive Services Task Force (USPSTF) recently reviewed, and highlights what the evidence tells us about the PSA test's benefits- which are uncertain or limited for many men- and the harms of treatment if a screening results in a prostate cancer diagnosis.
Prostate cancer screening and treatment made the news again this week with Warren Buffett’s announcement that he has early stage, localized, prostate cancer identified through the use of a PSA screening test. The 81 year-old Buffett is six years older than the recommended cut off age for regular PSA testing. He has opted for two months of radiation to treat the cancer. Both Buffett’s diagnosis and treatment choice has put the spotlight on a diagnostic tool and disease that is poorly understood by many people.
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 debate over the U.S. Preventive Services Task Force's (USPSTF) final recommendation on PSA testing continued this week. Michael Barry, president of the Informed Medical Decisions Foundation and Mary McNaughton-Collins, medical director, each had an opportunity to speak on NPR radio programs about the USPSTF recommendation this week. They voiced their views on the recommendation -- both from the perspective of the Foundation and as practicing primary care physicians.
In a guidance statement published Tuesday in the Annals of Internal Medicine, the American College of Physicians (ACP) joined the heated discussion on PSA testing by endorsing a shared decision making approach for prostate cancer screening. The ACP Clinical Guidelines Committee developed this guidance statement after reviewing current guidelines on prostate cancer screening in the U.S.
To this end, a shared decision making approach is appropriate for decisions about prostate cancer screening due to the preference-sensitive nature of the decision. We believe it is imperative that patient preferences be incorporated in the decision-making process and applaud the ACP for supporting a shared decision making approach for decisions about prostate cancer screening. By having an informed conversation about a diagnostic tool and disease that is often poorly understood, men can feel confident that they’ve made the decision that’s right for them.