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Post by Tony Crispino on Feb 25, 2015 10:40:19 GMT -8
The US New and World Report wrote an article this past week on the impact of the US Preventive Services Task Force (USPSTF) Grade D Recommendation to end all PSA screening in men for prostate cancer. The US News article seems to suggest that the impact is great. US News Article on increase in high risk cases for PCaHowever the National Institute for Health (NIH) however received an abstract that totally boggles the min and suggests that in fact there has been little impact at all by the USPSTF recommendation and that in fact there is no difference in the number of screening cases. The PSA test is being MORE used after initial screening and there has been less biopsy and more cautious approaches. Perez et al published Jan 2015 in PubMedNow one may discern that the increase in higher grade or more advanced cancers is related to the slower pace being instilled by urologists but that too would be in conflict with the Sonnybrook studies by Klotz and the UCSF studies by Carroll. What remains evident is that the US News article is reporting. The others mentioned here are written by the scientists. What also remains evident is the need for a registry in the US and time to gather discernible information |
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Post by Allen on Feb 25, 2015 16:23:00 GMT -8
US News is reporting on a study by Schultheiss et al. of 87,562 men across the US, which will be presented tomorrow at the GU conference. The Perez study is only reporting on 413 men treated at a single institution - Columbia Physicians & Surgeons. The Schultheiss study shows more men are arriving at a urologist's office with higher PSAs (over 10 ng/ml).
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Post by Tony Crispino on Feb 25, 2015 18:26:08 GMT -8
It will be interesting to hear the presentation. I want to see the full paper. Here's the abstract of the retrospective paper Schultheiss et alI am cautious about it for two reasons, first the studied period is from 2011-2013. And each year showed the increase by 3%. The USPFTF Grade D recommendation did not take place until May of 2012. The other paper I showed shows that there was not drop in PSA reporting and presentation to a tertiary care physician. I am trying to make the connection for the USPSTF recommendation that is suggested in the article. It's certainly possible. But it is not conclusively probable. |
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Post by Tony Crispino on Feb 25, 2015 18:31:13 GMT -8
Here is the USPSTF Statement Dated May 2012
If true, then the USPSTF must reconsider their recommendation. I am all for that. Combining Klotz and Carrol shows that screening works and active surveillance is a safe way to avoid over treatment. I hypothesize that the Schultheiss paper shows that active surveillance is not in reach of the primary care physicians and screening as usual is good but not if the PCP does not refer to a specialist.
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Post by Allen on Feb 25, 2015 22:11:54 GMT -8
The USPSTF recommendations were heavily publicized for at least a year before the policy went into effect. It is the heavy media coverage that patients and doctors would have responded to. The actual policy was a non-event after all that hoopla.
I will wait to see the full analysis before I react. But I note that the abstract says "No significant trends in Gleason score were observed; the frequency of men with higher T stages generally decreased over the entire period without a notable change after 2011." So it is only that men showed up at their urologists with higher PSAs (greater than 10). That's probably a result of greater levels of BPH that interfered with urinary function. If the PSA due to BPH were taken away, those same men might have been classified in lower risk categories.
The other point - that older men came in with higher risk disease - reflects a failing in the AUA guidelines, imho.
The other paper is useless for making generalizations because it only reflected the referral system at one extremely well-informed tertiary care facility. It does not at all reflect what went on in community practice throughout the country.
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Post by Tony Crispino on Feb 26, 2015 16:56:26 GMT -8
Actually the Draft Recommendation came out in 2009. It sat for almost three years while feed back was opened to the public. My first letter to them is dated January 2010.
Another thing happened around this time frame. It became more publicly noted about both dutasteride and finasteride having a masking affect of PSA readings.
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Post by Allen on Feb 26, 2015 18:10:27 GMT -8
Well, I wouldn't characterize it as a "masking effect," but I know what you're saying. In fact, what they do is make PSA more accurate as a biomarker for PC.
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Post by Tony Crispino on Feb 27, 2015 3:04:09 GMT -8
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