AACU Comments on USPSTF Draft Recommendation on Prostate Cancer Screening

2017-05-08 | AACU Executive Office

On May 8, the AACU submitted comments to the U.S. Preventive Services Task Force (USPSTF) regarding its draft recommendation statement for prostate cancer screening.

In short, the draft recommendation assigns a “C” grade to prostate cancer screening for men ages 55 to 69, thereby recognizing that the decision to screen for prostate cancer should be based on an individualized approached after discussion with a physician about the potential benefits and harms of screening.  The Task Force continues to assign a “D” grade for men age 70 and over, however, recommending against screening for all men in this age group.

USPSTF Draft Recommendation for Prostate Cancer Screening

Nearly five years after issuing its controversial blanket recommendation against prostate-specific antigen (PSA) based screening for all men regardless of risk, the USPSTF released an updated draft recommendation statement on April 11 that included a few key improvements.

Most importantly, the Task Force upgraded its recommendation on prostate cancer screening from a “D” to a “C” for men ages 55 to 69.  In doing so, the Task Force recognized the importance of individualized decision making about prostate cancer screening following an informed discussion with a physician regarding the potential benefits and harms.  The Task Force further acknowledged that African American men and those with a relevant family history are at an increased risk of developing prostate cancer and again reinforced the need for an individualized evaluation of the appropriateness of screening based on factors specific to each patient.

The Task Force did not, however, upgrade its recommendation for men age 70 and over, instead adhering to a “D” grade for these men.  The Task Force’s blanket recommendation against prostate cancer screening for this age group fails to take into account the increasingly longer life expectancies of many men age 70 and older, which in some cases exceeds men in their 50s or 60s.  So while the draft recommendation allows for men ages 55 to 69 to make an informed decision that weighs the potential benefits against the potential harms, it does not afford the same opportunity to men age 70 and above.

AACU Comments

The AACU’s comments on the draft recommendation touched on the following points:

  • We agree with the USPSTF draft recommendation statement on prostate cancer screening for men ages 55 to 69 years, which recognizes that the decision to screen for prostate cancer should be based on an individualized approached after discussion with a physician about the potential benefits and harms of screening.
  • We are satisfied that the Draft Recommendation specifically addresses men at increased risk of death from prostate cancer, including African American men and those with a relevant family history, and believe the proposed statement for men ages 55 to 69 years adequately avoids a blanket recommendation for all men, regardless of those factors.
  • We do not agree with the “D” grade for men age 70 and urge the Task Force to reconsider its recommendation against screening for this age group.
    • Many men age 70 and older may expect to live longer than men in their 50s or 60s and can experience the same potential benefits of individualized and shared decision making enjoyed by men ages 55 to 69 years.
    • We urge the Task Force to reconsider its rigid cut-off at age 70 and instead give men age 70 and older the opportunity to make the same balanced determination as men age 55 to 69 by assigning a “C” grade for all men age 55 and older.
  • We continue to caution against associating PSA-based screening with potential harms of overtreatment. Prostate cancer screening does not always lead to prostate cancer treatment; instead, it offers men the opportunity to delay active treatment and complications, or even avoid active treatment completely.

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