Twenty Years of Progress Battling Prostate Cancer Hangs in the Balance

This week, the U.S. Preventive Services Task Force (USPSTF) recommended healthy men no longer receive prostate-specific antigen (PSA) blood tests as part of routine cancer screening. This decision is being made by a panel that does not include a single urologist or medical oncologist and is chaired by a pediatrician. In 2009, this same task force suggested mammograms were unnecessary for women ages 40-49 and recommended against teaching women to do breast self exams.

As the CEO of Adult & Pediatric Urology, a urological practice with 9 physicians, 7 mid-level providers and more than 40,000 patients, serving neighbors and friends throughout Central Minnesota for over 30 years, we strongly disagree with the task force’s latest findings.

The scientific literature regarding screening is controversial and contradictory, with serious methodological flaws in even the largest studies. No new research has been cited that would call for this drastic change in prostate cancer testing recommendations since the USPSTF considered this issue in 2009. In fact, the most recently published study, the Göteborg Randomized Population-based Prostate Cancer Screening Trial (The Lancet Oncology, July 2010), found that with screening, deaths from prostate cancer dropped 44 percent over a 14-year period, compared with men who did not undergo screening.

Since 1994, even with screening, the incidence of prostate cancer has remained fairly stable, while simultaneously, the death rates from prostate cancer have declined by nearly 40 percent. Still, prostate cancer remains the second leading cause of cancer death in males in the United States, with the National Cancer Institute reporting that 33,720 men will die from this disease this year, more than one every 30 minutes.

Particularly troubling is that the USPSTF extrapolates risks of treatment onto screening.  But screening is not treatment, in fact, it is not even diagnosis; it is simply screening. There are essentially no risks to PSA screening since it involves a simple blood test. To deny patients the opportunity to participate in decisions regarding their own health care because of concerns regarding treatment they may never get is a scientific bait-and-switch of the worst order.

The USPSTF recommendation needlessly puts into harm’s way the men who are most at risk: the underinsured, those who live in rural areas where health care is not readily available, those who have a family history of prostate cancer, and particularly African-American men (who have the highest incidence of and death rates from prostate cancer).

Successful prostate cancer treatment depends on early detection, and studies demonstrate the screening efficiency for prostate cancer is similar to that for breast cancer. The USPSTF suggests that men without symptoms not be screened, but every urologist knows this is a tragic error.  By the time prostate cancer symptoms emerge, it is generally too late to cure. Adoption of these recommendations will undo more than two decades of progress, and result in the needless deaths of thousands of men.

Join me and contact your local and federal elected representatives to demand that these recommendations not be adopted. Comment at http://www.uspreventiveservicestaskforce.org/contact-uspstf/ or email the task force chair, Dr. Virginia Moyer, directly at moyer@bcm.edu.

Screening and treatment decisions should be determined between a man and his own doctor. The government should not able to deny a patient’s ability to access vital screening tests and his right to make informed life and death treatment decisions.

Steve Gerberding

CEO Adult & Pediatric Urology

Sartell, MN