Posted: July 7, 2015

One of the bases for scrapping routine PSA screening by the US Preventive Services Task Force (USPSTF) was the overtreatment of prostate cancer — i.e., men getting treated who would never have their longevity threatened by the disease.  It was this group’s perception that either watchful waiting or active surveillance (two ways to follow men with diagnosed but untreated prostate cancer) was underutilized.  Now the pendulum seems to be swinging back.  In a recently published extended letter to the editor in the Journal of the American Medical Association, Urologists from large real-world private Urology practices pooled their data to see whether practice patterns were changing.   Click here for the link or email Dr. Stark for the actual article. What they found was surprising and gratifying.  Among men thought to have the lowest risk of death from newly diagnosed prostate cancer (so-called CAPRA score 0-2) the likelihood of getting into a no treatment group rose from 15% to 40% between 1990 and 2010.  In men with higher CAPRA scores the rate stayed at about 10%.  Many of these men were considered in such poor health that something else would be expected to kill them first.  Among men over 75 years old, the rate of non-treatment rose to almost 80%.  The authors postulate that this trend should force us to re-look at the PSA test because a positive diagnosis no longer leads to reflexive radical treatment.  This is good news but leaves Urologists and their patients scratching their heads as to what to do.  Stay tuned for further developments.  Perhaps the USPSTF will modify its stance based on these new data.