May 22, 2013

By: Thomas A. Farrington, PHEN President and Founder

The May 3rd, 2013 publication of the American Urological Association (AUA) Guidelines for the early detection screening for prostate cancer makes this clarification statement at the very beginning: 

"It is important to note that the guideline statements listed in this document target men at average risk, defined as a man without risk factors, such as a family history of prostate cancer in multiple generations and/or family history of early onset below age 55 years, or African American race."

I have been highly critical of prostate cancer research, clinical trials and studies that do not include a representative number of African American and other men at high risk for the disease. This deficiency has now created situations where guidelines that will be used by the medical community have made no provisions for the men most affected by prostate cancer - an almost inconceivable set of circumstances. Even worse, these AUA guidelines will be extrapolated by the medical community as applicable for all men unless this issue is addressed with a sense of urgency.

I applaud the AUA panel for its honesty in directly acknowledging the lack of data and information necessary to include high risk men within its guidelines. This is in stark contrast to the U. S. Preventative Services Task Force (USPSTF) which similarly acknowledged a lack of data but still proceeded to include all high risk men within its recommendation against prostate cancer screening. The USPSTF simply opted to use a double standard.

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.

Black America, as the population 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.



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