The US Preventive Services Task Force (USPSTF) does not recommend PSA testing of men. Instead, it says that whether to test should be an individual decision based on a physician-clinician discussion of the potential benefits and risks.
Three researchers maintain that this stance is based on a misunderstanding of the data from two pivotal screening trials, which led to public uncertainty on the value of PSA screening. The misunderstanding includes both a “misinterpretation” of data, as well as not focusing enough on the length of follow-up when determining the benefit-risk profile of screening.
The first trial was intended to compare PSA screening with a control arm of no screening. However, nearly 90 percent of the control arm had received screening before or during the trial, making the study essentially a PSA screening versus PSA screening trial that could not measure the value of PSA testing.
The results from the other trial were evaluated after 16 years followup and the number of lives saved were judged not to be sufficient enough to recommend widespread PSA testing. However, if the followup had been extended to 25 years, the benefits of PSA testing would have been clearer, the researchers argue.
- See “PSA screening in prostate cancer: The controversy continues” by Jason M. Broderick on the Urology Times website (September 9, 2020)
- Full text of scientific paper “Reconsidering the Trade-offs of Prostate Cancer Screening” by Jonathan E. Shoag et al.