Reply by the Authors

Abstract

We read the letter to the editor with great interest and we agree that risk-stratified prostate-specific antigen (PSA) testing recommendations for specific subgroups (ie African Americans and men with a family history of prostate cancer) are currently under-represented in the updated United States Preventive Services Task Force (USPSTF) draft. However, we believe that it is important to point out that the most recent version is considered a draft recommendation, as the Task Force has invited experts all over the world to comment and controversially discuss its content. Against the backdrop of a lack of evidence regarding the benefit of differing screening recommendations in high-risk patients, 1 Bibbins-Domingo K. Grossman D.C. Curry S.J. The US Preventive Services Task Force 2017 draft recommendation statement on screening for prostate cancer: an invitation to review and comment. JAMA. 2017; 317: 1949-1950 Crossref PubMed Scopus (119) Google Scholar the updated current recommendation applies to a general population. That said, the Task Force has indeed discerned a necessity to address the issue of recommendations for specific subgroups and has devoted particular attention to this under-represented aspect of prostate cancer screening research. For example, the very first frequently asked question on the USPSTF's website (https://screeningforprostatecancer.org/) deals with the question “What does the Task Force recommend for men at high risk?”. It is concluded that to date, there is no correct answer about screening in men at increased risk of prostate cancer, given the void of evidence for these subgroups. In addition, the final USPSTF research plan intends to face key questions such as the effectiveness of PSA-based screening in certain subpopulations by performing systematic reviews, 2 U.S. Preventive Services Task Force Final research plan for prostate cancer: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/prostate-cancer-screening1Date: 2016 Google Scholar which will be incorporated into the final recommendation statement. We believe that screening approaches considering life expectancy estimations rather than applying absolute age criteria might be of value to account for both severe comorbidity and more aggressive tumors at an older age in men aged 70-80 years. Re: Vetterlein et al.: State-by-state Variation in Prostate-specific Antigen Screening Trends Following the 2011 United States Preventive Services Task Force Panel Update (Urology 2018;112:56-65)UrologyVol. 116PreviewThe authors studied state-by-state prostate-specific antigen (PSA)-based prostate cancer screening trends after the 2011 United States Preventive Services Task Force (USPSTF) recommendation against PSA screening. They found a significant nationwide drop in PSA-based screening after the 2011 USPSTF recommendations. Based on the peer reviewed urology literature, we also know that metastasis and death due to prostate cancer have increased since the 2011 USPSTF guidelines. An updated comparative study analyzing our US patients 3 years before (2010-2012) and after (2015-2017) the 2011 USPSTF recommendations will be published in June 2018. Full-Text PDF State-by-state Variation in Prostate-specific Antigen Screening Trends Following the 2011 United States Preventive Services Task Force Panel UpdateUrologyVol. 112PreviewTo evaluate state-by-state trends in prostate-specific antigen (PSA) screening prevalence after the 2011 United States Preventive Services Task Force (USPSTF) recommendation against this practice. Full-Text PDF