Rebecca Miksad, Founder and CEO of Miksad MD Consulting, shared on LinkedIn:
“From an early age, I learned that wise people change their minds when the evidence evolves. In medicine, that willingness can save lives.
The American Cancer Society (ACS) has just updated its prostate cancer screening guidelines, reflecting that principle. For me, it’s also personal because my father is a survivor of unexpectedly aggressive prostate cancer.
Concerns about overdiagnosis and overtreatment led to more cautious screening guidance from ACS in 2010 and a recommendation against routine PSA screening from the USPSTF in 2012.
Those concerns were valid, and screening rates fell. But subsequent trends raised important questions about unintended consequences.
Last year, ACS reported that regional- and distant-stage prostate cancer diagnoses increased 4.6-4.8% annually from 2014 to 2021, reversing earlier declines.
Meanwhile, the annual decline in prostate cancer mortality slowed from 3-4% to just 0.6%, even as mortality continued to improve for many other cancers.
These trends don’t establish causation, but they are concerning.
The new ACS guidelines recommend regular PSA screening, beginning earlier and more frequently for men at higher risk.
These recommendations bring population-level screening guidance into closer alignment with the American Urological Association’s risk-based approach, updated earlier this year.
As with all screening tests, the decision to test should be adapted for the individual situations and the risks/benefits shared with the patient
Importantly, screening isn’t just a test. What happens afterward matters just as much.
Both ACS and the AUA now emphasize confirming an elevated PSA and using MRI and/or biomarkers to guide biopsy decisions.
Together with active surveillance for low-risk cancers, these approaches can help identify dangerous cancers while reducing unnecessary interventions.
As ACS Chief Scientific Officer William Dahut put it, the goal is to ‘reduce prostate cancer disparities and ease the disease burden.’
There will undoubtedly be further analyses of the cost-effectiveness of these recommendations. In the meantime, clinical and coverage policies should evolve with the evidence.
Congratulations to Bill and the ACS team for their leadership.
Good medicine means being willing to reconsider what we thought we knew.”
You can also read: New Prostate Cancer Screening Guidelines Recommend Regular PSA Testing.
