All of us in the prostate cancer world know that the U.S. Preventive Services Task Force (USPTF) has announced its recommendation against routine PSA screening for men. There remains much debate and unhappiness in both the medical community (urologists and oncologists) as well as in the prostate cancer community itself.
There remains a lot of confusion since the PSA test, even when coupled with a DRE and a biopsy is not a full proof screening mechanism for the diagnosis of prostate cancer.
Even when there is an accurate positive diagnoses these tests do not tell us which cancer will progress and will not. His situation leads to over treatment.
On the flip side, men die from prostate cancer. Actually, prostate cancer is the second biggest cancer killer of men in the United States.
Treatment for prostate cancer, both advanced prostate cancer and organ confined prostate cancer has made remarkable gains in the last five years. Radiation is more accurate, surgical techniques have advanced, drug therapy options have expanded and we even have immune therapy!
On the bad news side is that the USPTF has said that screening is not necessary.
The USFTF, which is made up of primary care physicians, ob/gyn and pediatricians, did not have any urologists or oncologists on the board. Despite the fact that the urologic community and the oncology communities have argued that PSA screening has made a big difference in the battle of prostate cancer and has saved many lives.
This raging debate has culminated in a new bill called USPSTF Transparency and Accountability Act of 2012 (HR 5998). This bipartisan legislation, introduced on June 21 by U.S. Reps. Marsha Blackburn (R-Tennesse) and John Barrow (D-Georgia) along with U.S. Reps. Donna Christensen (D-Virginia) and Lee Terry (RNebraska), calls for significant changes to the U.S. Preventive Services Task Force and the process by which the group makes formal recommendations regarding preventive care services.
Most importantly, the bill strikes language added by the 2010 Patient Protection and Affordable Care Act that directly ties Medicare coverage of a particular preventive service to the grade given by the task force, which is primarily made up of general practitioners without input from specialists on specific diseases.
Another key change called for by the legislation is a requirement that a “balanced representation of primary and specialty care providers” and others in the healthcare community be involved in the development of recommendations.
These additions are a welcomed change, if they become law. However, the issue will continue to be debated as healthcare in general is debated, especially when there is limited funding and the cost of health care continues to rise.
Despite this debate, men should insist their primary care physicians offer them a PSA test.
Joel T Nowak, M.A., M.S.W.