In 2011, the U.S. Preventative Services Task Force (USPSTF) concluded that the harms of a prostate screening test outweighed the benefits, and recommended against such screening in many instances. The test at issue is the Prostate-specific antigen, or PSA test, which measures the level of PSA in a man’s blood that can be an indication of prostate cancer.
The USPSTF recommendation is contradicted by the American Urological Association and the American Cancer Society, who both note concern over PSA testing, but suggest that doctors and patients talk about the pros and cons of prostate cancer screening and proceed from there.
A recent study has shown that this recommendation has been broadly accepted, and fewer American men are receiving prostate cancer screening. The overall rate of PSA testing dropped 50% at primary care clinics operated by one hospital after the task force recommendations, the study shows.
You can read and abstract about these findings here:
[TRENDS IN PSA UTILIZATION BY PRIMARY CARE PHYSICIANS: IMPACT OF THE USPSTF RECOMMENDATION][1]
Urologists behind the study fear that the task force’s recommendation will lead to more men dying of prostate cancer that could have been detected and treated. Other doctors see the reduction as a positive trend, moving away from unnecessary testing. The argument behind the USPSTF recommendation is that men with prostate cancer usually don’t die from their cancer, while surgery or radiation therapy to treat prostate cancer can lead to impotence or incontinence, significantly harming a man’s quality of life to cure a cancer that likely isn’t life-threatening.
Critics of the guidelines point out that the largest decrease in screening was among men aged 50 to 70; the population that is most likely to benefit from screening. There was no change in men in their 40’s or men older than 70.
Perhaps most concerning is the misunderstanding surrounding the USPSTF recommendation: a majority of doctors surveyed in the study thought that the task force also recommended against digital rectal exams for prostate cancer, and as a result more than one-third said they perform fewer rectal exams.
The potential legal implications of this controversy are twofold. First, any disagreement on a guideline typically indicates an unsettled or amorphous legal standard of care for physicians practicing in that field. Failing to diagnose cancer is an issue that is frequently seen in malpractice cases, and the lack of consensus in testing will often weaken the case of a patient whose PSA was not tested, and thus, whose prostate cancer was not caught.
Second, the study highlights the danger of doctor’s misinterpreting changing guidelines, or making assumptions about the proper treatment in light of new studies and altering their practice to, arguably, substandard care. Specifically, the large number of providers who assumed that digital rectal exams were no longer recommended put their patients at risk by not performing testing that had not been discredited.
[1]: http://www.aua2015.org/abstracts/abstractprint.cfm?id=PD44-02 “TRENDS IN PSA UTILIZATION BY PRIMARY CARE PHYSICIANS: IMPACT OF THE USPSTF RECOMMENDATION”
