AUA, LUGPA back USPSTF reform legislation

The AUA, Large Urology Group Practice Association (LUGPA), and American Association of Clinical Urologists (AACU) would like to see the U.S. Preventive Services Task Force (USPSTF) revamp the methods it uses to develop recommendations on prostate cancer screening and other preventive care, and the three associations are now backing legislation that would do just that.

The legislation comes amid new concerns that the diagnosis of higher risk prostate cancer is on the rise.

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The nation's three largest urology groups announced their support for the USPSTF Transparency and Accountability Act of 2015, introduced by Reps. Marsha Blackburn (R-TN-7) and Bobby Rush (D-IL-1). Of note, the bill includes a mandate to ensure that a “balanced representation of primary and specialty care providers” and other key stakeholders in the health care community are involved in development and review of USPSTF recommendations.

Other key changes called for by the legislation strike the language added by the Affordable Care Act that directly ties Medicare coverage of a particular preventive service to the grade given by the USPSTF.

The AUA said in a news release that as part of this involvement, the USPSTF would be required to:

• publish a draft research plan (including analytic frameworks, key questions, and a literature search strategy as well as methodologic guidelines for the project) to guide the systematic evidence review process

• consider findings and research by federal agencies and departments

• make the evidence review available for public comment

• coordinate activity with other departments

• consult with “external subject matter experts,” including provider and patient representatives.

The bill establishes a Preventive Services Task Force Board comprised of providers, patient groups, and federal agency representatives. This group would provide recommendations to the USPSTF and suggest evidence for consideration, and also provide feedback on recommendations and help disseminate them when finalized.

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“I am concerned that decisions are being made without proper input from the specialists who treat these diseases,” Rep. Blackburn said. “Our legislation would require common sense coordination among relevant agencies and stakeholders while protecting the doctor-patient relationship. I’m happy to join Congressman Rush in introducing this legislation to ensure that preventive care recommendations are not made in a vacuum. Patients and their physicians have the right to choose which tests are best for them.”

In 2012, the USPSTF issued a “D” grade for prostate cancer screening using the PSA test.

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“The USPSTF made its prostate cancer testing recommendations without input or perspective from the urology community or any other cancer care experts and that continues to be a real concern as patients get mixed messages about testing,” said AUA Public Policy Chair David F. Penson, MD, MPH. “We don’t yet know the long-term impact that the USPSTF prostate cancer recommendations will have on U.S. men, but recent data from the National Oncology Data Alliance just presented [in late February 2015] indicate that men newly diagnosed with prostate cancer are presenting with higher PSA levels since 2011, perhaps due to decreased screening earlier in the disease course in response to the USPSTF recommendation.

“Importantly, these data show an increase in the number of higher-risk prostate cancer cases diagnosed between 2011 and 2013. Whether or not this is definitely related to the USPSTF recommendations remains to be seen, but this is what one would expect if PSA testing declined in response to the USPSTF recommendation. USPSTF could benefit from the input of specialists when evaluating these data,” Dr. Penson said.

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LUGPA said the National Oncology Data Alliance findings “confirmed LUGPA's earlier warnings about the potential public health catastrophe that could result from implementation of the USPSTF recommendation,” a LUGPA news release said.

"LUGPA joined an overwhelming international consensus of urologists, prostate cancer patients, and patient advocacy groups in opposition to the USPSTF's recommendation to stop prostate cancer early detection efforts," said LUGPA President Gary Kirsh, MD. "The bi-partisan effort let by Reps. Blackburn and Bush prevents Medicare from denying coverage for services based on USPSTF ratings and opens the process to the scrutiny of the public and experts in the field. Passage of this bill will ensure that future panel recommendations are clinically appropriate and will keep clinical decision making between patients and their doctors."

In a statement, Mark D. Stovsky, MD, MBA, president of AACU, said: “Our organizations represent an overwhelming consensus of urologists who support this bi-partisan effort led by Reps. Blackburn and Bush, which has the potential to reverse the destructive effects of the USPSTF recommendation against prostate cancer screening. Passage of this bill will ensure that patients are empowered to make well informed health care decisions.”

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