Your Community: A Focus on PSA Screening with BOB

Brotherhood of the BalloonThe Brotherhood of the Balloon , or BOB, is a COMPPARE Partner Organization with10,000 members from all 50 states and 39 different countries. The following article appeared in BOB’s September newsletter, BOB Tales. To learn more about BOB, visit https://protonbob.com/about-bob.

The Long-term Benefits of PSA Screening

Routine PSA testing may have benefits that aren’t evident in short- term studies, according to new commentary published in The New England Journal of Medicine. Experts suggest the advantages of widespread screening, including reduced mortality and the potential to avoid metastases, are likely greater than previously gauged.

The PSA Timeline

The PSA test was developed in the 1980s. In 1994, the Food and Drug Administration approved it as a screening tool for prostate cancer.

In 2002, the U.S. Preventive Services Task Force (USPSTF) claimed there wasn’t enough evidence to recommend either for or against routine PSA testing. They were confident that PSA screening could detect early-stage prostate cancer, but found mixed and inconclusive evidence that early detection improved health outcomes. A concern was that PSA screening was associated with important harms including false-positive results, unnecessary biopsies, infection, and potential complications from treatment of cancer that may never have affected a patient’s health.

In 2008, the USPSTF recommended against prostate cancer screening for men age 75 and older. At the same time, they concluded that for men younger than 75, the benefits of PSA testing were uncertain as the balance of benefits and harms couldn’t be determined.

In 2012, the USPSTF recommended against routine PSA screening for men in the general population regardless of age. As a result, the use of PSA testing declined significantly. At the same time, metastatic prostate cancer in older men began to rise after reaching an all- time low in 2011.

In April 2017, the task force reevaluated its stance against routine PSA testing and asked clinicians to “individualize decision making” about screening.

In May 2018, the USPSTF released their final recommendation on PSA testing recommending men ages 55 to 69 make an individual decision after discussing the potential benefits and harms and their specific clinical circumstances with their clinician. For men 70 and older, they concluded the potential benefits don’t outweigh the harms, and these men shouldn’t be routinely screened for prostate cancer.

The Latest Research

Investigators from Weill Cornell Medicine, New York Presbyterian, University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center aimed to better understand the benefits of PSA testing and help more men receive the right treatment at the right time, while reducing the risk of metastasis. They suggest the recommendations by the USPSTF and some others are based on “problematic estimates of the benefits and harms of screening.” They believe the evidence indicates that more widespread screening would reduce mortality rates and help patients avoid metastatic disease.

The authors of this latest analysis say current decision aids are based on an incomplete picture and that the time frame examined – generally 13 years from screening – isn’t long enough. “Most men who begin screening in their 50s will live much longer than 13 years. We need to look over a lifetime to understand the risks and benefits of screening,” says co- lead author Dr. Jonathan Shoag.

After analyzing data from previous studies and making conservative assumptions, researchers suggest, the survival benefits of screening became more apparent with longer follow-up. “Our results show that continued accrual of benefit over time creates a significantly more favorable picture of the value of screening,” said co-author Yaw Nyame, MD.

“More men should have the opportunity to get the benefits of screening. In my opinion, these outweigh the potential harms over a longer, more realistic time horizon for most healthy men,” said Shoag.

Contact the COMPPARE Team