The highly qualified independent panel convened by the AUA appears to have conducted an exhaustive and thorough analysis of “available” data to develop a set of guidelines for “average risk men.” My reading of the AUA guidelines and the processes used to develop them leads me to conclude that they are what they are, and highly supported by the data. I hope these guidelines serve to move everyone away from the regressive USPSTF recommendation against early detection screening for all men. This will be a step in the right direction, at least for “average risk men.”
The problem before us all today is that there are no definitive prostate cancer early detection guidelines for high risk men (men with a family history of prostate cancer and African American men). It is hard to imagine that such a serious void exists for those that are most impacted by the leading cause of cancer among men. I believe the medical community has an obligation to find an approach to address this void, and not use the AUA Guidelines and/or the USPSTF recommendation as cover where there is no evidence that they apply.
I urge the AUA and the National Comprehensive Cancer Network to immediately convene a panel for the specific purpose of developing prostate cancer early detection guidelines applicable to high risk men. We all understand that there exists a lack of data to extract from PLCO (Prostate, Lung, Colorectal and Ovarian) or ERSPC (European Randomized Study of Screening for Prostate Cancer) randomized clinical trials. However, there is relevant data within treatment centers and longitudinal databases that are applicable to treating high risk men. Guidelines developed via a methodology using a retrospective analysis of existing data and expert opinion is certainly preferable to a “no comment” from the medical community.
Early detection guidelines to meet the medical needs of men at average risk for prostate cancer, while protecting them from unnecessary potential harms are very much needed. How could this be less true for high risk men? It could in fact be argued that guidelines for the men most likely to face prostate cancer should be the priority. Clearly, high risk men are placed at an even higher risk without a roadmap for patients or doctors to have an informed discussion about prostate cancer early detection. Having interfaced and worked with many of the medical experts in the field I know we can do better than this, and we must.
The black community, which is most impacted by prostate cancer, must be at the forefront in demanding clarity in early detection screening guidelines. In addition, PHEN stands ready to work with a panel to develop prostate cancer early detection guidelines for high risk men.