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Routine PSA: Evaluating the Evidence Sheldon Greenfield, MD Health Policy Research Institute University of California, Irvine October 23, 2012

Routine PSA: Evaluating the Evidence

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Routine PSA: Evaluating the Evidence. Sheldon Greenfield, MD Health Policy Research Institute University of California, Irvine October 23, 2012. Management of Intellectual Conflict of Interest. - PowerPoint PPT Presentation

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Page 1: Routine PSA: Evaluating the Evidence

Routine PSA:Evaluating the Evidence

Sheldon Greenfield, MDHealth Policy Research InstituteUniversity of California, Irvine

October 23, 2012

Page 2: Routine PSA: Evaluating the Evidence

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 screening2. 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 expectancy4. Leave it to the patient and the doctor to

decide (USPSTF Level C)

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