Black men and those with a family history of the disease not helped by recommendation
In 2011, the U.S. Preventive Services Task Force (USPSTF) issued guidelines that recommended against routine prostate specific antigen (PSA) testing to curb over-diagnosis and overtreatment of prostate cancer. Since then, PSA testing has dropped by 28 percent, according to a new study. The relaxed guidelines, researchers say, may delay treatment of aggressive cancer.
“On the positive side, there is a lot of prostate cancer that we don’t need to know about,” said lead researcher Daniel Barocas, M.D., an assistant professor of urologic surgery at Vanderbilt University, referring to low-risk cancers that don’t kill most men. “On the negative side, we seem to be missing intermediate and high-risk cancers in men who would be eligible for treatment. Those are missed opportunities to identify disease and treat it.”
Using the National Cancer Database, researchers analyzed the effect of the new guidelines on the number of new prostate cancer diagnoses between January 2010 and December 2012 and found the number of prostate cancer diagnoses dropped more than 12 percent in the month after the guidelines were issued. The rate continued to drop to an overall decline of 28 percent in the year after the guidelines were issued, suggesting the USPSTF’s recommendations had the desired effect. Low, intermediate and high-risk prostate cancers were all diagnosed at significantly reduced rates, but diagnoses of prostate cancer that had spread beyond the prostate did not change.
Most prostate cancers found by PSA screening are the slow-growing, non-life-threatening variety, said Kirsten Bibbins-Domingo, M.D., vice chair of the USPSTF. “When the task force reviewed the evidence on PSA screening for prostate cancer in 2011, what we found is that there is a very small potential benefit and significant potential harms.”
But researchers on the new study say the USPSTF’s guidelines did little for men at high risk of the disease, including those with a family history and black men, who have the highest rates of prostate cancer in the world. “The policy of screening no one is throwing the baby out with the bathwater,” Dr. Barocas said, suggesting that screening should be combined with treatment. Low-risk cancer can be watched, while high-risk cancer should be treated, he said; “that’s the solution.”
It should be noted that since 2011, when the USPSTF released the guidelines, new techniques, including ultrasound and MRI, have been developed that can diagnose prostate cancer more accurately and distinguish between low- and high-risk cancers. These techniques may need to be taken into account and used in conjunction with the guidelines.