New, expanded work by USPSTF to examine evidence of PSA harms/benefits

This new work is not yet in-motion, but USPSTF release draft plan to systematically examine this set of questions:

1. Is there direct evidence that prostate cancer-specific antigen (PSA)-based screening for prostate cancer reduces short- or long-term prostate cancer morbidity and mortality and all-cause mortality?
---Does the effectiveness of PSA-based screening vary by subpopulation/risk factor (e.g., age, race/ethnicity, family history, and clinical risk assessment)?

2. What are the harms of PSA-based screening for prostate cancer and diagnostic followup?
---Do the harms of PSA-based screening for prostate cancer and diagnostic followup vary by subpopulation/risk factor (e.g., age, race/ethnicity, family history, and clinical risk assessment)?

3. Is there evidence that various treatment approaches for early-stage or screen-detected prostate cancer reduce morbidity and mortality?
---Does the effectiveness of these treatment approaches vary by subpopulation/risk factor (e.g., age, race/ethnicity, baseline PSA level, family history, comorbid conditions, and clinical risk assessment)?

4. What are the harms of the various treatment approaches for early-stage or screen-detected prostate cancer?
---Do the harms of these treatment approaches vary by risk factor (e.g., age, race/ethnicity, baseline PSA level, family history, comorbid conditions, and clinical risk assessment)?
---Do the harms differ by treatment approach?

5. Is there evidence that use of a prebiopsy prostate cancer risk calculator, in combination with PSA-based screening, accurately identifies men with clinically significant prostate cancer (i.e., cancer that is more likely to cause symptoms or lead to advanced disease) compared to PSA-based screening alone?

Also see PC Infolink article here: /prostatecancerinfolink.net/2016/04/28/uspstf-has-modified-research-plan-regarding-risksbenefits-of-psa-screening/

Post Edited (JackH) : 4/28/2016 2:53:11 PM (GMT-6)

I wish they would verbalize better. Testing and screening cause no harm. Yes I'm being picky.
No, I'm not picking a fight.

The image says it correctly, "Harms of treatment"

Thanks for providing the info!!

these clowns and their agents have caused enough harm. .

ed

shudderingThud said...
How long is this research likely to take?

I didn't see any timeframes included at their site. This is just a draft of a research plan...step 1 of what looks like a 3-step process. Step-1, they'll finalize the plan then Step-2 embark on a systematic review of the available evidence by researchers at established and independent “evidence-based practice” research centers. The resulting evidence review may then be used by the USPSTF in Step-3 as the basis for a new set of recommendations on PSA testing/screening. Again, I don't see any timeframes, but that's how I see it unfolding. I'd guess well into 2017, at least.

F8 is spot on .... in my opinion they have caused harm.

While I think it's a good thing that they are revisiting the mess they created a few years ago, I wonder what their masters will allow them to determine and publish. Pardon my cynicism, but they have not yet proven themselves to be helpful yet.

At least in this forum, they are not trusted as honest brokers.

And while we're at it, let's do away with colo-rectal screening, A1C testing, mammograms, MRI's in general, cardiac stress tests, and all these other medical procedures that cause anxiety (often without cause) and sometimes lead to surgeries or other treatments that some might find to be unnecessary.

I just went through a complete cardio workup, with stress echo, nuclear stress test, and even a cardiac cath. Lots of anxiety and supposedly all is fine....but oh, the anxiety, the worry, the possibility of a needless procedure.

OK, I'm being a little silly here. I was glad to have the tests. Knowledge is a good thing. But, I must say that this constant obsessing about the PSA blood test is driving me away from this very worthwhile website. You would think this simple blood test is more dangerous than ISIS.

In truth, I have no problem with any of the tests listed above. Knowledge trumps ignorance. It's not the knowing that is dangerous, it's what we choose to do with the knowledge gained. If some physicians are over-treating using only PSA test results, we can change that. It's not the test folks, it's the decisions that may or may not be made based on the test results. That's what we need to get right.

We're jousting at windmills. We're using up all our ammunition on the wrong target. I've never seen a problem fixed when the wrong cause is addressed. For crying out loud, let's quit obsessing about the PSA test and concentrate on figuring out the appropriate treatment using the PSA results and other criteria. Let's work to make sure doctors and patients are smart in their decisions, but let's also respect a man's right to choose the treatment he finds reasonable and best for him physically and emotionally.

Or, we can get rid of the PSA test and let the problem fix itself by allowing the cancers to fester until they become symptomatic and are beyond "cure." Which seems to be the preferred course of action (or inaction).

You know, I wonder why the PHI or some similar test does not replace the PSA test as the standard test.

Is it cost?


Clocknut: You hit it right on. I would say 90% of HW folks got dx. as a result of PSA testing (perhaps coupled, in a few cases, with an abnormal DRE). As you said, if they did not do the PSA testing, then many of them would end up in far worse straits, symptomatic with a very advanced case of PC.



Mel

I want to join the majority chorus here and state that this USPSTF attempt is an exercise in futility. The waters will be more muddled than ever, I predict, once a report is published.
Once that happens, the media will make some noise, and try to 'explain' the findings. Unfortunately, many of these 'explanations' will be distorted, if not outright wrong.

It will be interesting to see whether my prediction will be (mostly?) correct.

Post Edited (Sr Sailor) : 4/29/2016 10:01:18 AM (GMT-6)

What I did point out was that we don't benefit from hollow huffing and puffing. Suggesting we just throw up our hands (and throw everything out the window) is mindless posturing. Where's the effort, or interest, in improving. I am really looking forward to the USPSTF making an improvement on where we were in 2012.

How about moving to some meaningful conversation. Do you have anything to comment on Question-1? What about Question-5? How about one of the ones in-between? Something meaningful? Anything?

I agree with clocknut.

Besides, why discuss now. I am sure someone will link the findings the minute they are available, whenever that may be. Until then, there really isn't much to get ruffled over.

Post Edited (Dan0) : 4/29/2016 1:19:22 PM (GMT-6)

alephnull, well said.

When I looked back at the previous thread that he so kindly linked back to (who has the time to continually find pull quotes and file them for future use?), my primary objection to this study is the whole design of it. In their preliminary write up, the language clearly defined biopsy under the list of 'unnecessary treatments' to be studied.

Biopsy is NOT a treatment. It is a diagnostic tool. I don't know of any doctors today who move patients from a single high PSA straight into the OR. 20 years ago? Maybe. I think my dad (diagnosed in the early 90's) went to treatment after PSA and DRE. I don't recall him ever mentioning a biopsy...and he's been dead for 12 years so I can't ask.

The questions they are examining are worthwhile, but they do presuppose the hypothesis that PSA ALONE causes harm. Now, if harm is defined as upsetting a patient and saying 'you need some more testing to figure out what is going on', then I guess all doctors who are engaged in diagnosing pretty much anything are guilty of causing harm.

Looking at the list again, I suggest that question 5 is moot. Again, at least in the US, are there doctors who go directly from elevated PSA with no other diagnostic tools used directly to treatment? The only stories like that I've ever seen are those who have super high PSA readings that give an immediate lupron shot before doing the bone/cat scans and so on.

My thoughts on Question-1. If you've got thoughts on Question-1, I invite you to add them here. If you don't want to talk about the USPSTF, then don't...

1. Is there direct evidence that prostate cancer-specific antigen (PSA)-based screening for prostate cancer reduces short- or long-term prostate cancer morbidity and mortality and all-cause mortality?
---Does the effectiveness of PSA-based screening vary by subpopulation/risk factor (e.g., age, race/ethnicity, family history, and clinical risk assessment)?

People use to think that the decline in PC mortality which followed the peak reached in 1993 was largely because that was about when PSA-based screening began rolling out more widespread. Few doctors (except Dr Catalona, who has a "stake" in that being true) believe this to be the case today. Most believe PSA-based screening may have had a minor contribution, but not the most significant portion...so I think that this question will be meaningful to shed light on the relative value of PSA screening. I think this is a good question to ask.

This theory was largely debunked in the medical community because of the lag time of a screening program, and the unique characteristics of PC being typically slow growing versus the frequency timing of screening programs for effectiveness. A great article on this was published HERE which basically demonstrated that the strong correlation simply is not there.

Secondly, there is a strong correlation between the decline in mortality and the "golden era of PC drugs" which have been coming out one after another to extend the lives of men with advanced PC. It doesn't "save" everyone, but there's no doubt about the string of drugs introduced since early 90's, which was when HT began being widely used, has been impressive. Today, the question is largely "what is the correct order/sequence to take all the available drugs?"

Third, there has been recent correlation to the drop in smoking rates since early 90s and the increased mortality. PC Infolink recently did an article HERE covering that. It is WIDELY accepted that smoking makes PC much worse, and we simply have been having fewer and fewer people smoking.

I think the drill-down investigations for this question will also be potentially VERY meaningful to men, as we get more and more into personalized, individualized medicine and examine which subpopulations, if any, might benefit more from PSA-based screening. The answer doesn't appear to be everyone; but maybe it's some people.

I think this (Question-1) will be a meaningful examination.

(I'll comment on the others individually later.)

thoughts?