What You Should Know
In May 2018, the U.S. Preventive Services Task Force (USPSTF), a government task force–comprised of members from the fields of primary care and preventive medicine–that makes evidence-based recommendations about clinical preventive services, released revised recommendations about prostate cancer screening. This guidance recommends clinicians discuss the benefits and risks of prostate-specific antigen (PSA) testing with men ages 55 to 69.
These modified government recommendations are now in direct alignment with the AUA's Early Detection of Prostate Cancer clinical guideline and those from most other major physician groups - including the American Cancer Society, the American College of Physicians, the American Society of Clinical Oncology and the National Comprehensive Cancer Network, all which advocate for shared decision-making.
In addition to now more closely aligning to the AUA and most other major physician groups in terms of prostate cancer testing, the USPSTF further aligned itself by acknowledging African American men and men with a family history of the disease are at higher risk of being diagnosed with prostate cancer and should discuss with their physicians, the benefits and risks of testing in order to make a shared, informed decision about whether prostate cancer testing is right for them As part of their new recommendations, the USPSTF also recommended men over the age of 70 not be screened for prostate cancer. Regarding this advice, the AUA believes that select older, healthier men may benefit from prostate cancer screening and should, therefore, talk to their doctors about the benefits and risks of prostate cancer testing.
Under the Patient Protection and Affordable Care Act (ACA), USPSTF recommendations influence the level at which private insurance plans and public programs, such as Medicare, must provide coverage for certain tests and services. Payors must provide full coverage - with no cost sharing or copays - for those tests and services receiving an A or B rating by the USPSTF.
The AUA is committed to preserving patients' access to appropriate prostate cancer testing and is working at both the federal and state levels to educate lawmakers on this important issue. Nationally, the AUA is working with lawmakers to advance the USPSTF Transparency and Accountability Act and monitors legislative, as well as regulatory activity at the local level.
Frequently Asked Questions
What were the original USPSTF recommendations?
In 2012, the USPSTF released recommendations against PSA testing in men of all ages, regardless of risk. These recommendations were in stark contrast to guidance from most major physician groups, including the AUA.
Do the new recommendations mean insurance providers will now pay to cover the PSA test?
Under the ACA, payors are required to cover (with no copay) services and tests with USPSTF ratings of A or B. However, ACA Section 2713 also explicitly states that this "should not be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by the USPSTF or to deny coverage for services that are not recommended by such Task Force."
Did the AUA play a role in the development of these new recommendations? If so, how?
Yes. In January 2017, the USPSTF asked the AUA to to nominate expert urologists to review and provide feedback on its PSA recommendation evidence report, and our expert was chosen to be a part of the process. This was the first time that the USPSTF involved the AUA in developing recommendations, and it provided an opportunity for us to speak to the clinical nuances of prostate cancer and to the research nuances and limitations that may not always be obvious to providers who aren't active in the prostate cancer space. In 2016, the AUA also provided feedback to the task force on the research plan that informed the evidence report. After the release of the draft recommendations in 2017, we provided comments on the draft document.
Patient Education Materials
Prostate cancer is the second-leading cause of cancer deaths in men.
The following free tools are available to help the health care community and the public better understand and implement the AUA's Early Detection of Prostate Cancer guideline:
- Prostate Screening Wall Chart [PDF in English]
- Prostate Screening Wall Chart [PDF in Spanish]
- Prostate Cancer Brochure [PDF in English]
- Prostate Cancer Brochure [PDF in Spanish]
- Visit UrologyHealth.org/PSATest for additional patient education materials.
The following video and podcast are also available: