“Shooting for the Moon” means reducing metastatic prostate cancer diagnoses

The following letter to the editor was written in reply to the Urology Times article Aggressive prostate cancer diagnoses on the rise, which was published on this site on April 25, 2022.

Jonathan Henderson, MD

The rise in metastatic prostate cancer seen after the U.S. Preventive Services Task Force (USPSTF) recommended against routine prostate-specific antigen (PSA) screening was not surprising, as this circumstance has been suggested by other similar research in recent years. As an independent physician and practicing urologist, I would argue that the current USPSTF recommendation continues to devalue the critical role of PSA testing by maintaining a C grade.

This rating expresses an alarming level of indifference toward a worrisome trend of rising metastatic disease at diagnosis. Compounding the issue, insurance providers are sometimes less likely to cover the costs of screenings when ratings, like those issued by the USPSTF, remain outdated and unreflective of both patient needs and current data.

As we reemerge from the pandemic and from a significant decrease in cancer screenings across the board, I see an immediate need for increased patient access to screening, not less. Prostate cancer is still the second leading cancer-related cause of death in men in the United States, and screening is especially important for those at high risk—including Black men who are twice as likely to die from prostate cancer than white men.

In February, the Biden Administration relaunched the cancer moonshot project with a partial goal to diagnose cancer earlier by increasing access to screenings and focusing on racial and regional inequities. As part of this initiative, I strongly encourage the Biden Administration also advise the USPSTF to reconsider their official recommendations for PSA tests. Providers must be allowed to counsel patients on evidence-based best practices, considering an individual’s risk factors and a patient’s personal preferences.

Many lives may not have been lost had prostate cancer been detected earlier. We have an incredible opportunity to save countless more lives with better screening practices and renewed recommendations, which accurately reflect the realities we as independent physicians see within our patient populations every day.

Jonathan Henderson, MD, is president of the Large Urology Group Practice Association (LUGPA).