PSA Screening: Game Over? Well, Maybe
September 1, 2014 less than 1 minute read
In 2008, the United States Preventive Services Task Force (USPSTF) guideline made one of the first steps toward reducing the number of persons screened for prostate cancer by indicating the lack of value for persons ≥ 75 years. Four years later, their recommendations were updated into a guideline that advised notperforming prostate cancer screening on any men, since benefits could not be confirmed to outweigh risks. So, game over?
A study performed under the leadership of faculty from the University of Chicago department of urologic surgery analyzed data from the National Health Interview Survey, an ongoing interview done annually on 87,500 people in the United States. The subgroup chosen for analysis in this report focuses on men in two age groups: 65-74 years and ≥ 75 years. Results of these populations when queried in 2005 and 2010 were compared.
Was the 2008 caveat issued by the USPSTF heeded? For men aged ≥ 75 years, investigators found no meaningful difference in the rates of prostate cancer screening comparing results from 2005 interviews (36% screened) and 2010 interviews (34% screened). The majority of these men reported that their physician had advised them to undergo the screening, with only about 25% of men reporting any discussion of potential disadvantages of prostate cancer screening.
Guidelines are only guidelines: That is, it is the artful application of clinical judgment to science that should produce therapeutic wisdom. Nonetheless, clinicians should always carefully examine their process when acting in a way that is directly countercurrent to major national guidelines.
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