"Part of the reason the task force came down so hard is because this [informed consent] has not been happening," said Dr. Brawley, professor of hematology and oncology at the Emory Clinic in Atlanta.
Another reason, he said, is that "we have all these mass screening events going on. Not only is there no informed decision-making done and not only is there no information regarding harms, but men are being told screening can only benefit them."
Dr. Brawley outlined these and other considerations in a second editorial that accompanies the recommendations.
Going forward, Dr. Brawley recommends that physicians provide patients with a brief, written handout on prostate cancer that summarizes the task force recommendations, including potential benefits and harms of PSA screening. Patients could review the information prior to seeing their physician and then opt in or opt out of this screening, he said.
The American Cancer Society provides a patient handout on "Testing for Prostate Cancer" online. The USPSTF also is posting guidance for physicians on counseling patients in light of its new recommendations.
Dr. Moyer acknowledged that the issues surrounding PSA screening are emotionally charged. "Change is stunningly hard," she said. Our understanding of cancer dates back to the 1950s or earlier. Our thinking has been that you get one cancer cell in your body and then it’s a march to imminent death. We now recognize that cancer is not a monolithic thing."
Regarding prostate cancer, she added, "For the vast majority of men, it will not affect them in their lifetime."
"Unfortunately, at the moment, the PSA is the only test we have," Dr. Moyer said. "The test itself is not very good. The PSA test is too sensitive – it picks up almost anything that happens to the prostate." She added. "The dream is that a better test is developed."
Dr. Moyer and Dr. Brawley had no relevant financial disclosures.