Looking to submit comments regarding the USPSTF recent PSA screening recommendation?
Want to submit your comments to the U.S. Preventative Services Task Force (USPSTF) regarding the recent PSA screening recommendation and would like some guidance with how to answer the questions. We have prepared, with the help of our Scientific Advisory Board, some answers that will help get you started.
Be advised the comment period ends on November 8, 2011.
How could the USPSTF make this draft Recommendation Statement clearer?
While making the recommendation clearer is a laudable goal, it is to improve the content of the recommendation. The USPSTF likely underestimated the potential benefits of PSA screening by relying on data that has important limitations. The PLCO control arm was heavily contaminated and while the claim has been made that the size of the study was increased to account for this confounder, the absence of the expected proximal effect of screening (substantial increase in the number of cases diagnosed along with downward stage migration) strongly suggest that the PLCO was unable to compare regular screening to a truly unscreened population. Further, the degree of benefit is likely underestimate due to the limited follow up of the studies cited by the USPSTF. In a disease that takes a long time to kill its victims, additional follow-up would have likely resulted in a more favorable number needed to screen and number needed to treat estimates provided by the European study. Since the USPSTF recommendations are based on estimates of risk and benefits, an underestimation of benefits is a critical deficiency of the recommendations.
What information, if any, did you expect to find in this draft Recommendation Statement that was not included?
Adequate follow-up and a balanced analysis of the shortcomings of the trials that provided key data are missing.
The USPSTF does not acknowledge that prostate cancer stage at diagnosis was much higher prior to the PSA era than is seen currently. The randomized studies did not convincingly show this suggesting that the control groups cannot be considered to accurately represent unscreened populations.
There is not adequate acknowledgment of the opportunities to reduce the morbidity of screening by decoupling diagnosis from treatment and offering surveillance to lower risk individuals.
Based on the evidence presented in this draft Recommendation Statement, do you believe that the USPSTF came to the right conclusions? Please provide additional evidence or viewpoints that you think should have been considered.
We believe that the USPSTF significantly understimated the potential benefits of screening and did not fully account for strategies that can also reduce the risks of screening. As a result, the USPSTF reached the wrong conclusion. The USPSTF failed to adequately acknowledge the limitations of existing data.
What resources or tools could the USPSTF provide that would make this Recommendation Statement more useful to you in its final form?
Assuming that the Recommendation Statement is revised adequately, easy to use web-based tools that help individual men better understand their individual risks relevant to the decision whether or not to pursue screening. These might include probabilities of various outcomes with or without screening. Outcomes may include being diagnosed with prostate cancer, aggressive prostate cancer, metastatic prostate cancer; as well as the risk of dying from prostate cancer. Other outcomes might include risk of an abnormal test result, biopsy, treatment, side effects, etc. We need to provide men with a solid estimate of what is likely to happen, both on the benefit and the risk side of the equation if they chose to be screened or choose to forego screening.
The USPSTF is committed to understanding the needs and perspectives of the public it serves.
Please share any experiences that you think could further inform the USPSTF on this draft
Recommendation Statement.
Recommendation Statement.
Please add your own personal experiences/story regarding PSA screening and the importance of early detection.
Do you have other comments on this draft Recommendation Statement?
Add comments as you see fit.
Please note the comment period opened on October 11, 2011 and will close November 8, 2011. Be sure and get your comments in prior to November 8, 2011 and encourage others to do the same.
Thank you for your support and helping to ensure this downgrade of the important PSA screening test does not happen.
