New prostate specific antigen guidance should serve as 'catalyst for change'

The long-standing controversy over the value of prostate cancer screening heated up last fall when the U.S. Preventive Services Task Force issued a recommendation against routine screening. In this exclusive interview, Peter R. Carroll, MD, MPH, discusses the positive and negative aspects of the recommendation and provides a unique perspective on how the urology community should respond. Dr. Carroll is professor and chair of urology at the University of California, San Francisco, and served as chair of the AUA's 2009 PSA best practice statement update panel. He was interviewed by Urology Times Editorial Consultant J. Brantley Thrasher, MD, professor and chair of urology at the University of Kansas Medical Center, Kansas City.

Q. As you know, on Oct. 7, 2011, the U.S. Preventive Services Task Force issued a statement recommending that the PSA test no longer be used for the early detection of prostate cancer. Please briefly summarize the USPSTF's recommendation.

Q. I think we all saw the response to the statement from Dr. Sushil Lacy, current president of the AUA. What was your take on that response?

Q. In your opinion, what is the real value of the task force's recommendation? Do you see this as a bit of a wake-up call for urology?

I would also point out that we've seen a substantial-39%-reduction in prostate cancer mortality over the past 2 decades, and that actually accounts for approximately 20% of the overall reduction in cancer death rates in men. It is thought that half of the decline in mortality is due to early detection and half due to improved treatment. The impact of early detection on declining mortality has been substantial. We don't want to go backwards. Let's use this report to refine and improve our approaches to early detection.