If you thought U.S. doctors would never accept evidence-based medicine, consider this: Just last week, in a stunning about-face, the American Urological Association(AUA) announced that it no longer recommends routine annual PSA testing for men under 55.
The organization added that “men ages 55 to 69 who are considering the PSA test” for prostate cancer “should consult their doctors about the test’s benefits and risks.”
The potential “benefit of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade” should be weighed “against the known potential harms associated with screening and treatment [which include side effects such as incontinence and impotence } For this reason, “ shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening,” The AUA stressed that “ patients’ values and preferences” should direct a final decision.
.In addition, the AUA announced that “to reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening.
I wrote about “shared decison-making” and how it could help patients considering a PSA test make an informed choice here on HealthBeat back in 2007.(Readers interested in why this protocol is so important to patient-centered medicine may be interested in this story that I wrote for Dartmouth Medicine: “Making Choice An Option.” ) Congratuations to the AUA for having the courage to take this giant step forward into the future of medicine.
“The new guideline is significantly different than previous guidance,” the organization acknowledged, noting that it “was developed using evidence from a systematic literature review rather than consensus opinion.” In other words, urologists didn’t take a vote; they looked at the Science.
Authors of the new guidelines have “learned very quickly that there really was no high-level evidence supporting the use of screening with PSA,” said urologist H. Ballentine Carter, who chaired the panel that wrote the new guidelines.”
When I last wrote about PSA testing, in July of 2012, such a radical shift in the AUAs positions would have been unthinkable. At the time, the U.S. Preventive Services Task Force (USPSTF) had given PSA testing a grade of “D”—suggesting that benefits did not outweigh risks.
In response, urologists joined forces with Republicans to threaten the autonomy of the USPSTF by supporting a House bill (H.R. 5998) that proposed to mandate “greater role for specialists and advocacy groups” in developing guidelines” while ”eliminating the Department of Health and Human Services’ secretarial discretion to withhold Medicare funding for interventions that lack convincing evidence for benefit.”
What a difference a year makes.