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Fallout Over PSA Guidance Continues— Specialty Groups Dissent, Congress Attacks
The American Society of Clinical Oncology earlier this week issued a
“provisional clinical opinion” that recommends physicians discuss prostate-
specific antigen testing with asymptomatic patients whose life expectancy
is ten years or longer.
The guidance contradicts the recommendations by the U.S. Preventive
Services Task Force, which gave routine PSA testing of asymptomatic men
the grade “D,” which means that the task force has concluded that there is
at least moderate certainty that the harms of doing the intervention equal
or outweigh the benefits in the target population.
While the USPSTF grade applies to all men, ASCO’s provisional opinion
distinguishes between men with a life expectancy of 10 years or more from
men with a life expectancy of fewer than 10 years. For men in the latter group,
ASCO does not recommend PSA testing.
“For men with a shorter life expectancy, we agree that the risk of harms
associated with PSA-based screening and subsequent unnecessary treatment
likely outweigh the benefits,” said Ethan Basch, co-chair of the ASCO panel, and
associate attending oncologist and outcomes research scientist at Memorial
Sloan-Kettering Cancer Center.
“But for men with a longer life expectancy, our assessment of the evidence
shows the balance of risks and benefits is less clear, and that well-informed
conversations between men and their physicians remain worthwhile about harms,
potential benefits, and appropriate management strategies if prostate cancer
The recommendation was printed in in the Journal of Clinical Oncology,
which ASCO publishes. The society also released a decision aid for weighing the
risks and benefits of screening. Both are available at: http://www.asco.org/pco/psa.
The Cancer Letter’s conversation with Basch appears on page 1.
The recommendation comes at a time when USPSTF is facing political
backlash over the prostate cancer screening recommendations and its earlier and
equally unpopular recommendation on mammography.