It is important that we all add comments to the “Opportunity for Public Comment – Screening for Prostate Cancer: USPSTF Recommendation Statement DRAFT at the following URL

https://web.archive.org/web/20111210163948/http://www.uspreventiveservicestaskforce.org:80/uspstf%5Fform3/

I chose to make the following comments:

I am concerned and strongly disagree with the conclusion the Task Force has made. To reduce the rating to “D” is in direct contradiction to the many studies demonstrating a significant survival advantage from men who are tested as well as being in direct contradiction to the Task Forces’ own conditional statements as to when PSA testing could be used.

A “D” rating recommends that there be no testing. However, your recommendation says that as long as a man has been explained the reason for the PSA test along with its positive and negative issues surrounding the test it should be made available, subject to his approval. A “D” rating does not express this clear message and will make PSA tests unavailable to most men, even if your preconditions have been satisfied.

You have decided to ignore multiple studies1 that have clearly demonstrated that PSA testing saves lives. Instead you are relying on one faulty study (PLCO) where the evidence is clear that the control groups were badly contaminated.

I believe that allowing symptoms to progress to the point that men become symptomatic borders on being criminal. Once symptomatic the disease is no longer curable. Identifying men with disease that is still in the gland and usually non-symptomatic allows curative treatment. How can we deny a man the chance to cure his cancer?

Many men are subjected to unnecessary procedures and side effects. This is over treatment, not over testing. The PSA is a s blood test; side effects are due to poor counseling post-test and over anxious physicians. The problem is not the PSA test, but the decisions resulting from poor counseling. This problem can be rectified with proper education and remuneration of physicians for counseling.
Every man has the right to know if they have cancer and make appropriate clinical decisions under careful and studied guidance from their physician.

In conclusion, it is extremely important that you do not readjust the current rating of the PSA test.

1 REFERENCES:
1. “2006 Fact Book” National Cancer Institute, U.S. Dept. of Health and Human Services.
2. “Mortality results from the Göteborg Randomised Population-based Prostate Cancer Screening Trial.” The Lancet Oncology. July 1,2010. Hugosson, J. et al.
3. “Prostate cancer mortality in screen and clinically detected prostate cancer: Estimating the screening benefit.” European Journal of Cancer, October 3, 2009. Van Leeuwen, P.J. et al.
4. “Prostate cancer mortality reduction by prostate-specific antigen-based screening adjusted for nonattendance and contamination in the European randomised study of screening for prostate cancer (ERSPC).” European Urology, July 28, 2009. Roobol, M.J. et al.
5. “Randomized trials of prostate cancer screening.” Reviews in Urology, Summer 2009; 11(3):179-180. Loeb, S. et al.
6. “Screening and prostate-cancer mortality in a randomized European study.” New England Journal of Medicine, March 2009; 360(13): 1320-1328. Schroder, F. et al.
7. “Does PSA testing save lives? – A Critical Analysis of Two Randomized Trials.” Dr. Patrick C. Walsh. Johns Hopkins University. 2009.
8. “Lower detection of prostate cancer with PSA screening in US than in European randomized trial.” Journal of the National Cancer Institute, February 8, 2010.
9. “The screening of prostate cancer in 2009: Overview of the oncology committee of the French Urological Association.” Prog Urol, January 2010, 20(1):17-23.
10. “Screening decreases prostate cancer death: First analysis of the 1988 Quebec prospective randomized controlled trial.” Prostate, February 1999; 38(2):83-91, Labrie F. et al.
11. “Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: A population-based study in middle-aged men.” Cancer Causes and Control, 2007; 18(9): 931-937. Agalliu, Ilir et al.
12. “Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria.” Urology, 2001; 58(3):417-24. Bartsch G. et al.