The Arkansas Prostate Cancer Foundation's Response to the United States Preventative Service Task Force

Little Rock - May 22, 2012 – The U.S. Preventive Services Task Force issued a “D” recommendation against the use of PSA screening in the detection of prostate cancer. The Arkansas Prostate Cancer Foundation is deeply disappointed in yesterday’s announcement and the detriment that it will cause to men and their loved ones.

The USPSTF has released its final recommendation and advocates against the use of PSA testing in healthy men who ‘do not have symptoms that are highly suspicious for prostate cancer.’ In other words, they recommend against PSA screening and state that there is moderate or high certainty the screening has no net benefit or that the harms outweigh the benefits. “We realize PSA testing isn’t perfect, but it’s currently all we have; and in combination with a physical exam, it’s really the best chance of catching prostate cancer in its early stages when it typically manifests no symptoms.” commented Lauren Talbot, Executive Director of the Arkansas Prostate Cancer Foundation. 

In its evidence-based review, the USPSTF relied heavily on the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial, which many authoritative sources consider to be significantly flawed. There are however, two large European based screening trials that are less flawed, have a longer follow-up and found a significant decrease in the death rate from prostate cancer in men being screened with PSA (European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Göteborg randomized population-based prostate-cancer screening trial). The Göteborg trial found a 44% risk reduction in prostate cancer death and the ERSPC found a 20% risk reduction in the screened group.  Most authorities agree that since the advent of PSA based screening for prostate cancer, the prostate cancer-specific mortality rate has continually dropped.  Studies have also shown that since the introduction of PSA screening in the 1980s, the percentage of men that present with organ confined prostate cancer has gone from 25% to approximately 91% now, and at the same time the 5 year cancer-specific survival rates have gone from approximately 70% to 100%. “With the advent of PSA based screening the percent of men presenting with metastatic disease has declined by roughly 75%,” states Matthew Katz MD, Assistant Professor in the Division of Urologic Oncology, Department of Urology, UAMS. “Although it is certainly true that we over treat prostate cancer in this country, I do not believe that we should go back to not screening anyone for prostate cancer and firmly believe that at the minimum we should be screening for risk. In that I mean, men with family history of prostate cancer and African American men,” states Katz.

"Over 217,000 men are diagnosed with prostate cancer each year. That’s one in six. Around 32,000 men die of the disease.  Recommending against PSA is going to take us backwards; we will start to see more men dying from the disease,” stated Talbot. 

The American Urological Association recommends that rather than instructing primary care physicians to discourage men from having a PSA test, the Task Force should instead focus on how best to educate primary care physicians regarding targeted screening and how to counsel patients about their prostate cancer risk. The PSA test has allowed us to move beyond a time when men presented with high-grade, metastatic disease for which there were little or no treatment options other than palliative care. In its earliest stages, most prostate cancers cause no symptoms; to say that only men with symptoms of prostate cancer should be tested will potentially result in a return to such a time.

Thousands of families—especially those of men who are high risk, African American men, men with a family history and veterans exposed to Agent Orange—rely on the PSA to detect cancer early so that their loved ones are around longer. The Arkansas Prostate Cancer Foundation would encourage further use of shared decision-making, whereby men together with their healthcare providers discuss the individual risk of prostate cancer and decide whether PSA screening is appropriate. 

APCF in the Profiles Series (Discovery Channel)

APCF Participates in the Department of Defense Prostate Cancer Research Program

APCF Presentation at the Annual ZERO Summit to End Prostate Cancer Meeting

The 2011 Summit to End Prostate Cancer brought almost 200 advocates from around the country together to learn about advocating for prostate cancer.

The program included talks about current and emerging research, and various ways to advocate at community, state and national levels.September 20, 2011

APCF Executive Director, Helen Baldwin, gave a presentation, titled State Activism: Effective Advocacy at Home. 

APCF Represented at the 7th Annual African American Prostate Cancer Disparity Summit

APCF at the Annual NASPCC Meeting

The 7th Annual Meeting of the National Alliance of State Prostate Cancer Coalitions (NASPCC), was held October 14-16, 2011 in Chicago and attended by Executive Director, Helen Baldwin. State organizations shared best practices and strategized advocacy related to the USPSTF draft recommendation against prostate cancer screening.