Decision aids are important tools in ensuring patients understand the medical choices they face. Our decision aid "Is a PSA Test Right for You?", takes a look at the same medical evidence that the U.S. Preventive Services Task Force (USPSTF) recently reviewed, and highlights what the evidence tells us about the PSA test's benefits- which are uncertain or limited for many men- and the harms of treatment if a screening results in a prostate cancer diagnosis.
Prostate cancer screening and treatment made the news again this week with Warren Buffett’s announcement that he has early stage, localized, prostate cancer identified through the use of a PSA screening test. The 81 year-old Buffett is six years older than the recommended cut off age for regular PSA testing. He has opted for two months of radiation to treat the cancer. Both Buffett’s diagnosis and treatment choice has put the spotlight on a diagnostic tool and disease that is poorly understood by many people.
The U.S. Preventive Services Task Force (USPSTF) published their final recommendation on PSA testing in an Annals of Internal Medicine article this week. The panel advises against PSA-based prostate cancer screening for men of all ages. The rationale for this recommendation is based on the panel’s moderate certainty that the potential harms outweigh the benefits for all age groups. Based on clinical evidence from two large randomized trials evaluated by the panel, at most 1 out of 1,000 men screened will avoid dying from prostate cancer over 10 years, while many more men will be left with permanent disabilities from their treatment, such as incontinence (18 in 1,000) or impotence (29 in 1,000).
The debate over the U.S. Preventive Services Task Force's (USPSTF) final recommendation on PSA testing continued this week. Michael Barry, president of the Informed Medical Decisions Foundation and Mary McNaughton-Collins, medical director, each had an opportunity to speak on NPR radio programs about the USPSTF recommendation this week. They voiced their views on the recommendation -- both from the perspective of the Foundation and as practicing primary care physicians.
In a guidance statement published Tuesday in the Annals of Internal Medicine, the American College of Physicians (ACP) joined the heated discussion on PSA testing by endorsing a shared decision making approach for prostate cancer screening. The ACP Clinical Guidelines Committee developed this guidance statement after reviewing current guidelines on prostate cancer screening in the U.S.
To this end, a shared decision making approach is appropriate for decisions about prostate cancer screening due to the preference-sensitive nature of the decision. We believe it is imperative that patient preferences be incorporated in the decision-making process and applaud the ACP for supporting a shared decision making approach for decisions about prostate cancer screening. By having an informed conversation about a diagnostic tool and disease that is often poorly understood, men can feel confident that they’ve made the decision that’s right for them.
The month of November has just begun and so has the sprouting of mustaches. The mustaches aren’t necessarily a response to the colder weather, but a sign that “Movember” is here -- a month dedicated to raising awareness about various men’s health issues through facial hair growth. While there are many topics within the men’s health umbrella, this charity chooses to focus on the most prominent ones, mental health, testicular cancer and prostate cancer. While all of these topics are important, prostate cancer tends to receive the spotlight as it affects 1 in 6 men.
There has long been a debate surrounding the issue of prostate cancer screening, especially around the PSA test and whether it should be standard practice. The Informed Medical Decisions Foundation has long been involved in this debate and continues to take the stand that this decision is a personal one that every individual man should make after talking to their provider and receiving all the facts about the test. As our president, Michael Barry puts it, “we believe weighing the pros and cons of the PSA test to arrive at a decision is an individual process.”
The Movember charity’s philosophy falls in line with that of the Foundation. They too believe that the decision to undergo a PSA test is a personal one, and each individual man should talk to their provider about getting screened. To help men with this decision, Movember provides a simple chart laying out the pros and cons of the PSA test. “Men who understand the key facts about the decision and have an opportunity to talk with a doctor about their values, can then make informed choices that are aligned with their preferences,” says Diana Stilwell, our chief production officer. We hope each and every man takes the time to understand the facts and reflect on his own preferences to make his own decision regarding the PSA test this Movember. Happy mustache growing!
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