LUGPA statement on UPSPTF Recommendations

On May 8, the United States Preventive Services Task Force (USPSTF) posted its Prostate Cancer Screening final recommendations.  https://screeningforprostatecancer.org/

LUGPA recognizes the decision by USPSTF to finalize its preliminary Grade “C” recommendation for PSA screening of men aged 55-69 is an improvement over its 2012 one-size-fits-all recommendation against PSA-based screening for any man. Yet, our organization has grave concerns that the USPSTF continues to minimize the importance of shared decision making for both older men in good health and younger men at high risk, both populations that may benefit from prostate cancer screening.

LUGPA firmly believes that in order to optimize patient–physician shared decision-making for both diagnosis and treatment of prostate cancer, healthcare providers should have the ability to counsel patients upon evidence based best practices that consider the individual patient’s specific medical condition and needs. The application of arbitrary age cutoffs negates not only physician’s expertise and knowledge of an individual patient’s specific health history, but also undermines recent breakthroughs in molecular and genomic testing that facilitate personalized, precision healthcare delivery.

The USPSTF’s decision to finalize the draft recommendations it released more than a year ago is the byproduct of a process that is neither open nor transparent.  The USPSTF continues to be exempt from the Federal Advisory Committee Act (FACA); as such, it is not obliged to hold meetings in public, consider public comments, disclose its methodology, nor is there any recourse for those harmed by its decisions.  LUGPA commends the bipartisan efforts underway in Congress to reform the USPSTF process through the USPSTF Transparency and Accountability Act of 2017.  This legislation, if enacted, provides for commonsense reforms that both preserve the advisory capacity of the USPSTF while simultaneously restoring basic oversights that apply to all advisory committees with similar authority.  LUGPA will continue to work with the bill’s sponsors and co-sponsors for to help take this important step in preserving the health and well-being of Medicare beneficiaries

While LUGPA appreciates USPSTF’s acknowledgment for the need of additional research with respect to prostate cancer screening, particularly as it relates to men who are African American and those with a family history of prostate cancer, we do not believe that the final recommendation is sufficient.  There is ample data to suggest that subsequent to the USPSTF’s 2012 Grade “D” recommendation, many fewer men have been screened for prostate cancer and those being diagnosed with prostate cancer are being found with later stage, more aggressive disease.  Tragically, cure rate for these patients is much lower, potentially leading to unnecessary deaths from prostate cancer.

LUGPA has always recommended that patient-physician shared decision making requires thoughtful and clear communication with men of all ages who might be at risk for prostate cancer diagnosis. For those patients with newly diagnosed prostate cancer, LUGPA believes a full discussion of all treatment options, which includes active surveillance and appropriate immediate interventions, is required. LUGPA believes that while the current guidelines do represent a step forward, they simply do not go far enough.  LUGPA remains committed to preserving the right of every man to access appropriate screening services after consultation with their healthcare provider.