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).
This recommendation makes it clear that the days of indiscriminate PSA testing should be over. However, while we agree with the panel’s interpretation of the evidence, the Informed Medical Decisions Foundation does not believe that a patient should be removed from the equation when making a decision whether or not to undergo a PSA test. No doubt there will be informed patients who will still want a PSA test, due to risk factors or other personal reasons. In addition, the medical evidence evaluated by the USPSTF only looked at outcomes of screening over 11 -13 years. Therefore, we don’t know how the trade-offs of risks and benefits will unfold after this period of time, and some men, particularly men in their 50’s and 60’s, will be considering the implications of their decision over a much longer time frame.
We applaud the Task Force’s careful evidence review and synthesis of the results, but we believe weighing the pros and cons of the PSA test to arrive at a decision is an individual process. Uncertainty in medicine is more common than we usually let on, and the way to address uncertainty is to allow informed patients to take on a central role in their health care decisions, through a process of shared decision making.