Expect Questions About Shift in Prostate Cancer Screening Recommendation


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A draft recommendation from the U.S. Preventive Services Task Force (USPSTF) advises that for men aged 55 to 69, the decision to be screened for prostate cancer should be an individual one, based on the man’s own values and priorities and discussions with a clinician about the potential benefits and harms of screening.1 Kirsten Bibbins-Domingo, PhD, MD, MAS, who chaired the Task Force when the draft recommendation was being developed, called it a shift from the Task Force’s 2012 statement recommending against prostate-specific antigen (PSA)-based screening for prostate cancer regardless of age.

Some of the widespread media coverage, however, characterized the draft recommendation quite differently, and these reports could generate questions from patients. For example, The Washington Post reported that the Task Force “has dropped its controversial opposition to routine screening for prostate cancer,”3 and the tagline that ran under the CBS This Morning report was “Cancer confusion: Doctors forced to grapple with varying guidelines.”4

“Nothing has changed about our emphasizing that men should be aware of the benefits and harms. What has changed is that there is new science.”
— Kirsten Bibbins-Domingo, PhD, MD, MAS

Fortunate for New Evidence

The PBS NewsHour introduced an interview with Dr. Bibbins-­Domingo about the draft recommendations by citing “confusion over conflicting science” and a “sense of whiplash.” In that interview, Dr. Bibbins-Domingo commented, “We’re fortunate that the Task Force has new evidence, and that led to the change in grade.”5 

For men aged 55 to 69 years, prostate cancer screening is now a grade C recommendation, meaning the decision should be an individual one based on potential harms and benefits and discussion with a clinician. In the 2012 recommendation statement, prostate cancer screening for all adult males was a grade D, meaning not recommended. 

“In the end,” Dr. Bibbins-Domingo said on PBS, “the most important thing for a given man is that he is aware of the science telling us about the benefits and harms and that he uses that to make the right decision for himself.”5 

Reason to Update Guidelines

“There is a reason we update our guidelines every 5 years,” Dr. Bibbins-Domingo told The ASCO Post. “There is new science. The public should be comforted by the fact that doctors and scientists are actually working hard to increase our knowledge about what works and to increase our knowledge about ways in which we can mitigate harm…. When the science is telling us something different about the balance of benefits and harms, we should be willing to make a shift in our recommendation.” 

She noted that even in 2012, when the Task Force concluded that the benefits of PSA screening did not outweigh the harms, the Task Force recognized the importance of informed discussions and individualized decision-making. “Nothing has changed about our emphasizing that men should be aware of the benefits and harms. What has changed is that there is new science.… That is why our recommendation has shifted to, ‘You should have a conversation with your doctor.’” 

Disclosure: Dr. Bibbins-Domingo reported no conflicts of interest.

References

1. USPSTF: Draft recommendation statement: Prostate cancer screening. April 11, 2017. Available at https://screeningforprostatecancer.org. Accessed May 24, 2017.

2. Moyer VA, on behalf of the USPSTF: Ann Intern Med 157:120-134, 2012.

3. McGinley L: The federal panel that opposed prostate cancer screening just changed its mind. The Washington Post, April 11, 2017.

4. New screening guidelines for prostate cancer. CBS This Morning, April 11, 2017.

5. Why this prostate cancer screening guideline just got reversed. PBS NewsHour. April 11, 2017.


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Kirsten Bibbins-Domingo, PhD, MD, MAS

For a man aged 55 to 69 years, the decision to be screened for prostate cancer should be an individual one, based on the man’s own values and priorities and discussions with a clinician about the potential benefits and harms of screening, the U.S....

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