Urologists not swayed by explanation of USPSTF PSA recommendation

Urologists who gathered for the annual Joint Advocacy Conference listened politely as a member of the U.S. Preventive Services Task Force explained the thinking behind the group's recommendation against routine PSA testing, but few, if any of them seemed to have been swayed.

Urologists who gathered for the annual Joint Advocacy Conference listened politely as a member of the U.S. Preventive Services Task Force explained the thinking behind the group’s recommendation against routine PSA testing, but few, if any of them seemed to have been swayed.

Michael LeFevre, MD, USPSTF co-vice chair, spent more than an hour on March 5 at the meeting just off Capitol Hill explaining how the task force concluded that there is moderate certainty that the harms of PSA-based screening for prostate cancer outweigh the benefits, thus resulting in a grade D recommendation.

The AUA and the American Association of Clinical Urologists have been among the recommendation’s strongest critics since its release in October 2011, saying that when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment, and monitoring of prostate cancer patients. The questions that Dr. LeFevre gamely fielded and the reaction afterwards indicated the urologists’ views had not changed.

Instead of using the microphones sprinkled around the audience for the question-and-answer session, moderator David F. Penson, MD, read select questions to Dr. LeFevre from a stack of index cards, many of them containing comments instead of questions. All of the cards were direct and to the point, Dr. Penson said afterwards.

"We greatly appreciate Dr. LeFevre taking time away from home and work to attend the Urology Joint Advocacy Conference," said AACU President Arthur E. Tarantino, MD. “Although his appearance was much like sending Daniel to the lion’s den, he was very effective at educating us as to the mission of the USPSTF, and we are extremely appreciative of his time.

"Although there are undoubtedly still serious disagreements between practicing urologists and the task force recommendations, we come away from this meeting better informed. However, our concern going forward is the message we send to our patients, especially those at high risk: African-Americans, Caucasians with a family history, and our veterans exposed to Agent Orange."

Many of the urologists’ questions focused on the validity of the studies underpinning the PSA recommendation and how the task force interpreted the data.

"Dr. LeFevre admitted that subjective 'judgment is involved in every step' in calculating the USPSTF’s recommendations," said Gary M. Kirsh, MD, chairman of UROPAC, the two groups’ political action committee. "Amongst respected outside experts-who the USPSTF purposefully excluded from participation in their deliberations-there is substantial opinion that the USPSTF’s methodology and judgment was significantly flawed, resulting in an incorrect conclusion by the task force on the value of PSA testing."

"Dr. LeFevre said that USPSTF found that the harms of prostate cancer treatment outweigh the benefits," said William F. Gee, MD, a urologist in private practice in Lexington, KY. "He could not adequately explain why prostate cancer deaths in the U.S. have decreased over the past 20 years since the introduction of PSA testing."

Asked what prompted him to accept the urologists’ invitation to appear, Dr. LeFevre said it fell on him to decide when the task force’s interests should be represented. He noted that USPSTF service is unpaid and he was appearing on his own time and at his own expense.

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