Memo to USPSTF: Hire a PR Pro

Merrill Goozner

Posted 10/18/11 on GoozNews

Last Friday at 3 p.m., the Agency for Healthcare Research and Quality held a telephone briefing to inform the press and public about the U.S. Preventive Services Task Force recommendation against routine screening of prostate specific antigen (PSA) levels in middle-aged men. The “D” recommendation, now open for public comment, said the harms from false positives and overtreatment of prostate cancer identified by elevated PSA levels outweighed any benefits that would be achieved by the early identification of the relatively small percentage of cases that would lead to metastatic disease and early death.

They posted no slides to go along with the three presentations made at the briefing. They didn’t spell out the names of the men who spoke (I scribbled down Moyer, Chou and LeFebre). And, when they concluded their presentations, they didn’t take questions.

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Prostate Cancer Screening – Is Science Winning?

Joe Paduda

First posted 10/07/11 on Managed Care Matters

Brian’s Note: Readers interested in this topic will also want to see “Can Cancer Ever Be Ignored” by Shannon Brownlee and Jeanne Lenzer, published yesterday in the New York Times Magazine.

The announcements this week that the United States Preventive Services Task Force has decided healthy men shouldn’t get the P.S.A. blood test is long overdue, but nonetheless very welcome news.

The test, which ostensibly screens for prostate cancer, is notoriously inaccurate, delivering a high rate of false positives and false negatives. And, men who get these tests have no greater chance of surviving the test than men who don’t.

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The Meeting That Wasn’t, Revisited

Kenneth Lin

First posted 10/05/11 on Common Sense Family Doctor

New York Times Magazine story published on the newspaper’s website this morning details the complicated history of screening for prostate cancer in the U.S. and revisits the related story of the U.S. Preventive Services Task Force meeting that was abruptly cancelled for political reasons on November 1, 2010, the day before the midterm Congressional elections. I was interviewed several times for this story, starting shortly after my resignation from my position at the Agency for Healthcare Research and Quality, where for 4 years I had supported the USPSTF’s scientific activities on a wide range of topics.

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Spare the Knife. Keep the Rod.

Who will tell the men?

That’s what I wondered last week when I read the abstract about prostate cancer patients’ grim prognosis for normal sexual activity after surgery or radiation for their disease. The study appeared in the Journal of the American Medical Association.  Tara Parker-Pope in the New York Times’ Well blog gave it a shot today, and led with an anecdote about a surgeon who blithely told one patient that 98% of his robotic surgeries turned out fine. Not exactly.

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It’s Time To Stop This [PSA] Screening Nonsense

Kenneth Lin

First published 6/21/11 on Common Sense MD

In an editorial in this month’s issue of the Journal of Family Practice, Northeast Ohio Medical University dean and family physician Jeff Susman, MD joins the rising chorus of voices urging clinicians to stop offering the PSA test to screen for prostate cancer. Dr. Susman writes:

I am going to go out on a limb here and suggest that, until we have fundamentally changed strategies for targeted case finding or early intervention (think genomic and proteomic markers), it is time to stop this screening nonsense. The facts speak for themselves: A trial of 182,000 patients finds in a post hoc analysis of a very narrow population that death can be averted in one of 723 individuals who are screened. What about the complications associated with diagnosis, work-up, and treatment? It is time for urologists and primary care physicians to tell patients that PSA screening is unlikely to benefit them. Some of you will suggest that we counsel patients about PSA testing to facilitate informed decision-making. But do we advise patients to play the lottery or try futile therapies? 

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PSA Testing: Will Science Finally Trump Politics?

Kenneth Lin

First published 2/28/11 on Common Sense MD

Maybe the third time will finally be the charm.

[DSC02696.JPG]In early November 2009, the U.S. Preventive Services Task Force voted unanimously to update its 15-month old recommendations on screening for prostate cancer in men younger than 75, changing its previous rating of “I” (insufficient evidence) to “D” (recommends against). But after a shocking political firestorm erupted over the Task Force’s new recommendations making mammography optional for women in their 40s, it decided to postpone finalizing the new statement pending a more precise estimate of the harms inflicted by indiscriminate PSA testing. As a medical officer at the Agency for Healthcare Research and Quality, I personally wrote the evidence review upon which the USPSTF based its initial recommendations and helped to commission and oversee an independent report of the harms of prostate cancer treatments authored by one of AHRQ’s Evidence-Based Practice Centers.

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