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Response to USPSTF Changes for Prostate Screening

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Read the full USPSTF Guidelines for Screening for Prostate Cancer.

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Overview

The United States Preventive Services Task Force (USPSTF) recently issued their recommended changes for prostate cancer screening in men. The current draft guidelines recommend against PSA screening for men of any age. In response to the concerns submitted by FORCE that the guidelines might not apply to people with BRCA mutations, the USPSTF modified these guidelines to reflect this important detail.

Background on USPSTF new guidelines

According to the USPSTF, the primary goal of prostate cancer screening is to reduce deaths due to prostate cancer. Research shows that screening using PSA increases detection of prostate cancer. However, PSA screening has risks and limitations including:

  • many of the cancers found are not symptomatic and will not progress to a point of affecting life-span or quality-of-life
  • PSA tests yield many false-positive results leading to unnecessary biopsies
  • treatment of prostate cancer can lead to serious side effects in about 7% of patients and less serious side effects in as many as 40% of patients

Given the above, the USPSTF analyzed research studies that looked at prostate cancer screening and outcomes to determine if the research showed a net benefit from screening. In October, 2011, the USPSTF issued draft guidelines that recommended again PSA screening for all men and invited input and feedback from organization and individuals.

Background on prostate cancer in BRCA 2 mutation carriers and FORCE response to USPSTF draft guidelines

FORCE contacted the USPSTF in response to the draft guideline changes and presented the following information:

Men with BRCA 2 mutations face

  1. a lifetime risk for prostate cancer that is much higher than men in the general population and may be as high as 33%,
  2. prostate cancer risk at a younger age than the general population, and
  3. risk for more aggressive prostate cancers.

Edwards et. al. recently published data which showed a poorer prognosis and overall survival for BRCA2 mutation carriers versus non-carriers diagnosed with prostate cancer. Based on this and previous work, BRCA2 mutation status is now recognized as an independent prognostic factor and marker of poorer overall survival. The IMPACT Trial is a large international study examining PSA in men with and without BRCA mutations. The study will be completed in 2020 and will determine if PSA screening improves detection and outcomes in mutation carriers. Early analysis from IMPACT suggests a benefit of PSA screening in men with BRCA mutations.

FORCE requested the USPSTF take into account the above concerns and we urged the addition of language to the guidelines to clarify that they are not meant for men with a BRCA mutation or those with a high-likelihood of carrying a mutation.

Conclusion

The USPSTF issued new prostate cancer screening guidelines on May 21, 2012.

  • The new USPSTF guidelines on prostate cancer screening recommend against screening in men of average risk for prostate cancer.
  • The USPSTF acknowledged that the guidelines do not apply to men with BRCA mutations.

The Task Force took into account our published concerns about prostate cancer in men with BRCA mutations and added the following statement to their guidelines:

"This recommendation...does not consider PSA-based testing in men with known BRCA gene mutations who may be at increased risk for prostate cancer."

  • FORCE encourages men with a BRCA mutation to participate in the ongoing IMPACT study by contacting the study coordinator at your closest study site.
  • FORCE encourages all men with BRCA mutations or cancer in their family to speak with health care providers with expertise in cancer and genetics for screening and risk-management recommendations.
  • FORCE encourages our community to help educate and spread awareness that these new guidelines do not apply to men with BRCA mutations. Most media reports on the new guidelines do not mention this detail and the language about mutation carriers is buried within the guidelines under the section Patient Population Under Consideration.

It is important to note that not all professional societies agree with these new guidelines and some believe that PSA screening should be available to all men after a conversation with their health care providers on the benefits and risks of screening.

References

Edwards et al. Two percent of men with early onset prostate cancer harbor germline mutations in the BRCA2 gene. Am J Hum Genet. 2003 72(1):1-12.

Edwards et al. Prostate cancer in BRCA2 germline mutation carriers is associated with poorer prognosis. Br J Cancer 2010 Sep 27;103(6):918-24.

Gallagher DJ, Gaudet MM, Pal P, Kirchhoff T, Balistreri L, Vora K, Bhatia J, Stadler Z, Fine SW, Reuter V, Zelefsky M, Morris MJ, Scher HI, Klein RJ, Norton L, Eastham JA, Scardino PT, Robson ME, Offit K. Germline BRCA mutations denote a clinicopathologic subset of prostate cancer. Clin Cancer Research, 2010 Apr 1;16(7):2115-21.

Kote-Jarai Z, et. al. BRCA2 is a moderate penetrance gene contributing to young-onset prostate cancer: implications for genetic testing in prostate cancer patients. Br J Cancer, 2011 Oct 11;105(8):1230-1234.

Mitra et al. Prostate cancer in male BRCA1 and BRCA2 mutation carriers has a more aggressive phenotype. Br J Cancer. 2008 Jul 22; 99(2): 502-507.

Mitra, AV, et. al. Targeted prostate cancer screening in men with mutations in BRCA1 and BRCA2 detects aggressive prostate cancer: preliminary analysis of the results of the IMPACT study. Br J. Urology. 2011 Jan; 107(1): 28-39.

Narod et al. Rapid Progression of prostate cancer in men with a BRCA2 mutation. Br J Cancer. 2008 Jan 29; 98(2): 371-374.

 

Page updated 05/22/12


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