In May 2018, the U.S. Preventive Services Task Force (USPSTF), a government task force that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services, released new prostate cancer testing guidelines stating asymptomatic men ages 55-69 are shown to benefit the most from prostate cancer testing; therefore, should talk to their doctor about whether prostate cancer screening is right for them. These new government recommendations are in direct alignment with the AUA's early detection for prostate cancer clinical practice 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.
High Risk Patients
In addition to now 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.
Men Over the Age of 70
Regarding the USPSTF's advice not to screen men over age 70, the AUA believes that select older, healthier men may garner a benefit from prostate cancer screening and should therefore talk to their doctors about the benefits and risks of prostate cancer testing.
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.
J. Brantley Thrasher, MD, FACS
AUA President, 5/17/2017 - 5/22/2018
J. Brantley Thrasher, MD, FACS is the William L. Valk Distinguished Professor, Department of Urology and the co-director of operative services at the University of Kansas Medical Center in Kansas City, Kansas. He completed his medical degree at the Medical University of South Carolina in Charleston, South Carolina, an internship at Walter Reed Army Medical Center in Washington D.C., and his urology residency at Fitzsimons Army Medical Center in Aurora, Colorado. He subsequently completed a urologic oncology fellowship at Duke University Medical Center. He served for three years as Program Director for the Urology Residency Program at Madigan Army Medical Center in Tacoma, Washington, and was then appointed to his present position in 1998.
Dr. Thrasher has served as President of the Society of Urology Chairpersons and Program Directors, the Society of Urologic Oncology, and as a member of the Residency Review Committee for Urology. He has served as Vice-President of the American Board of Urology and is a member of the American Association of Genitourinary Surgeons and of the Clinical Society of Genitourinary Surgeons.
He served as the South Central Section Representative to the AUA Board of Directors, as a member of the South Central Section Health Policy Committee, and is a former president of the South Central Section. He was previously the Chair of the Public Media, Practice Guidelines and Prostate Cancer Guidelines (vice-chair) Committees, a mentor for the AUA Leadership Program, a member of the Best Practice Policy Panel on Cryotherapy for the Treatment of Prostate Cancer, the Chair of the Prostate Cancer Literature Review Panel and the Audio-Visual Committee of the AUA. In 2015, he was awarded the Distinguished Service Award from the AUA, for 15 years of service to academic and organized urology. He is an associate editor for the book, "The 5-Minute Urology Consult;" Editor for Practical Reviews in Urology, and an Editorial Consultant for Urology Times. He has published more than 200 manuscripts, book chapters and monographs in the area of urologic oncology. He has been a member of the AUA since 1994.
David F. Penson, MD, MPH
AUA Public Policy Council Chair (2012-2016)
AUA Science & Quality Council Chair (2018-)
David F. Penson, MD, MPH is Hamilton and Howd Chair of Urologic Oncology, Chair of the Department of Urologic Surgery, Professor of Urologic Surgery, Medicine and Health Policy, and Director of the Center for Surgical Quality and Outcomes Research at Vanderbilt University. He obtained his MD from Boston University, completed his urology residency at UCLA Medical Center in Los Angeles, and then completed the Robert Wood Johnson Clinical Scholar fellowship at Yale University, while obtaining his MPH degree. He currently maintains a clinical practice in urologic oncology at Vanderbilt University Medical Center.
Dr. Penson's research is focused on the comparative effectiveness of treatments for localized prostate cancer. He is the Principal Investigator (PI) of the Prostate Cancer Outcomes Study (PCOS), a large population-based study of prostate cancer survivors funded by the NCI that includes the longest longitudinal patient-reported follow-up in the field. Dr. Penson is also the PI of the CEASAR study, a comparative effectiveness study of surgery vs. radiation for localized prostate cancer, funded by the US Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI). Over 3600 men have been enrolled in the CEASAR study that will determine "what works, in which patients and in whose hands." Dr. Penson's work has been published in a variety of journals, including the New England Journal of Medicine, JAMA, Health Affairs and JNCI.
Dr. Penson is also very active in the field of health policy. In addition to serving as Chairman of the American Urological Association's Public Policy Council, Dr. Penson has served on various committees in the National Quality Forum, the Ambulatory Quality Alliance, the AMA Physician Consortium for Quality Improvement and AHRQ's National Advisory Council.
About Prostate Cancer
Prostate cancer is the second leading cause of cancer deaths in men. More than 164,000 men will be diagnosed with prostate cancer this year. Over 29,000 will die from it. One in nine men will be diagnosed with prostate cancer in his lifetime, and one in six African American men will be diagnosed.
The following tools are available to help the health care community and the public better understand and implement the guideline:
- Prostate Cancer Infographic
- 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]
The following video and podcast are also available