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USPSTF Issues Final Recommendation on PSA-Based Screening By CINDY SANDERS

U.S. Preventive Services Task Force last month published its final recommendation for screening men for prostate cancer. After reviewing the evidence, the task force issued a ‘C’ recommendation for men ages 55-69 with an emphasis on “informed, individual decision-making based on a man’s values and specific clinical circumstances.� For men aged 70 and older, the task force issued a ‘D’ recommendation, noting such screening would not routinely be advised as potential benefits do not outweigh harms. The recommendation applies to all adult men who have no signs or symptoms of prostate cancer and who have not previously been diagnosed with the disease – including men at increased risk for the cancer. However, the recommendation statement incorporates specific sections to address higher risk populations with additional information for these men and their clinicians to consider during the decision-making process. While the final recommendation letter grades didn’t change from the draft report issued last year, USPSTF Vice Chair Alex Krist, MD, MPH, said some of the wording was refined after reviewing the feedback submitted from various

stakeholders during the public comment period. “It’s a little bit clearer that we’re trying to cue patients and clinicians in the factors that might lead Dr. Alex Krist a man to be screened or not be screened,� he said, adding there is an increased focus on this being an individual decision.

“Prostate cancer is one of the most common cancers to affect men, and the decision whether to be screened is complex,� Krist noted. “Men should discuss the benefits and harms of screening with their doctor so they can make the best choice for themselves based on their values and individual circumstances.� While the routine use of prostate-specific antigen (PSA) screening elicits strong opinions both for and against, Krist

pointed out the evidence-based USPSTF recommendation aligns with a number of other organizations, including the American Urological Association (AUA). While specific screening recommendations from the AUA, American Cancer Society, National Comprehensive Cancer Network, and USPSTF are somewhat varied in the details, all stress a shared decisionmaking component between patient and clinician. Krist – who is a professor of Family Medicine and Population Health at Virginia Commonwealth University, an active clinician, and director of community-engaged research at the Center for Clinical and Translational Research – said it is important for a physician and patient to talk about the clinical implications of screening in the context of that patient’s particular circumstances. “For some men, it may not even need a discussion,� he noted of patients facing competing health concerns that would significantly reduce or eliminate the need to worry about prostate cancer, which is typically slow growing. For others, who are at higher risk for the disease and expected to live more than 10 years, the decision should be weighed in terms of benefits versus harms. (CONTINUED ON PAGE 8)

  

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