In 2012 the influential United States Preventive Services Task Force (USPSTF) decreed that there was no value in PSA testing for prostate cancer as the “harms” of screening outweighed the “benefits” in terms of lives saved. This put the USPSTF at loggerheads with most expert American urological opinion but nevertheless resulted in a fall in PSA screening. The USPSTF was heavily criticised for having no prostate cancer specialists on its panel and also for failing to identify black African Americans and men with a family history of prostate cancer as being in special risk categories that require a proactive, informed approach to screening.
Since 2012 the proportion of American men presenting with advanced prostate cancer has risen and as more and more screening trials and advances in clinical practice are reported, the USPSTF’s position has become increasingly isolated.
It is therefore of considerable relief to hear that the USPSTF has drafted recommendations that support “discussion-backed decisions for men aged 55-69 based on clinician-patient discussion” that allow patients to make an informed decision based on up to date trial evidence and advances in clinical practice that have significantly reduced the risks of “over- diagnosis” and “over-treatment”.
It is to be hoped that the UK’s National Screening Committee will similarly move to a more positive stance on screening.