What's USPSTF, And How Does It Affect Prostate Cancer Screening?

If you are like most folks, you have never heard of the United States Preventive Services Task Force (USPSTF). The good news is you are not alone. Whenever I ask a group if they are familiar with USPSTF or how it impacts their health and the heath of family members, the room gets totally silent.

I explain the organization was founded in 1984 as an independent volunteer panel. The mission of USPSTF is to make recommendations on ways to improve the health of every American. The volunteers do so by making recommendations concerning how doctors, hospitals, and more should provide health screenings, counseling services, and preventive protocols.

A controversial recommendation

If we go back to 2008, we find USPSTF suggesting that it was uncertain whether screening men younger than 75 for prostate cancer had benefits, and that screening men 75 or older could do more harm than good.¹

The recommendation was based in part on the fact that a PSA testmight result in a false positive, which in turn may expose men to additional testing and the risks associated with such procedures. In 2012, USPSTF recommended against PSA testing for prostate cancer.²

It did not take long for men to get the idea that the whole process of PSA testing along with the “dreaded” digital exam was an avoidable experience. As men questioned the need, many general practitioners were willing to oblige. Sadly I still find doctors who believe men do not need to be tested.

A domino effect on prostate cancer screening

Once the recommendations were published, fewer men were screened at veterans hospitals.³ So, it seemed the belief was: if you are under 75 you don’t need to be tested, and if you are over 75 the good news is testing may not be valuable, as you most likely will die of something else.

For years afterward, the reported number of new prostate cancer cases dropped.^4,5 Apparently not testing men proved to some that fewer men had the disease.

It was a classic case of what is often call “Hoppy Toad Research.” For those not familiar with this kind of research, it begins with an observation and then uses research to prove the point. As the parable is told, a mythical research scientist speculates that frogs (hoppy toads) have ears in their hind legs. He set out to prove his theory.

When the frog is told to jump, the frog does so. Then the researcher removes one of the frog's back legs. When told to jump, the frog struggles. Our mythical scientist insists that the frog's hearing has been impacted. Silly story, but it makes a point.

More cases of advanced prostate cancer

At the same time that some concluded prostate cancer was declining, the number of advanced cases was rising.^4,6 It took time before anyone suggested that perhaps a lack of early testing was resulting in more advanced cases. African American men, in particular, were at risk, as they are both more likely to develop and die of prostate cancer than white men.

On a national level, several organizations began questioning the recommendation not to test. Finally, USPSTF reconsidered their rating and now suggests that men age 55-plus might find some benefit in PSA testing.⁷

PSA levels

Since age 40, I had been going in for annual physicals every year. Slowly my PSA numbers were climbing. At the same time, I was told it was ok because I was in the “normal” range.  When my number reached some unknown magic level, my MD suggested I may want to visit a urologist.

My urologist quickly pointed out there was no "magic" number. He suggested that any increasing number over time can be an indicator that something was not right. Since my diagnosis, I have discovered that different MDs (depending on training or level of knowledge) hold varied views on what PSA levels mean.

Based on personal experience, I believe it can be good to get PSA-tested in your early 40s, regardless of family history. I find it valuable to ask for your PSA number, and keep a written record of your PSA history. If there is an ongoing increase over time, it may be good to consider visiting with a urologist.

Chances of survival

While your GP may not feel an irregularity in your prostate, you have to  remember that only a portion of the prostate can be felt using a digital exam. A urologist could be more successful in identifying any issues.

Your chances for survival increase dramatically if you are diagnosed and treated early. From personal experience and conversations with other men, it appears that more than a few general practitioners are not aware of the many subtleties involved in a prostate cancer diagnosis. It is not unusual to find men who have been treated for an enlarged prostate or prostate infection, only to discover years later they were experiencing early stage prostate cancer.

You owe it to yourself and family to get tested.