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Routine PSA:Evaluating the Evidence
Sheldon Greenfield, MDHealth Policy Research InstituteUniversity of California, Irvine
October 23, 2012
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Management of Intellectual Conflict of Interest
“Academic activities that create the potential for an attachment to a specific point of view that could unduly affect an individual’s judgment about a specific recommendation”
- Clinical Practice Guidelines We Can Trust Institute of Medicine, 2011
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“Conclusions: Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality.”
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Why Doesn’t ScreeningWork Better?
• Co-morbidity (life expectancy)
• Lead time bias
• Over diagnosis bias (no progression over time)
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Clinical Policy Options
1. No routine PSA screening
2. Screen all over 50 or 55• Biopsy only those with PSA> 10 • Active surveillance for those with high
levels of comorbidity (decreased 10 year life expectancy)
• Treatment only by high quality urologists
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Clinical Policy Options (cont’)
3. Screen all those with high life expectancy
4. Leave it to the patient and the doctor to decide (USPSTF Level C)
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