This is something I teach our medical students about. The grade C recommendation is because PSA is not a great screening test for prostate CA and the risks are about equal to the benefits for those without a high risk (the groups you mentioned). PSA has l
ow sensitivity (21%) and it has high specificity (91%) so it's much better as a diagnostic test than screening. It also has a low PPV (30%). Also prostate cancer is usually slow-growing and often does not cause mortality. So although PSA screening offers a small potential benefit of reducing the chance of death from prostate cancer in some, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy and treatment complications such as incontinence and erectile dysfunction. In my primary care practice, we don't offer PSA to men who don't express a preference to be screened. I would apply the same logic to patients living with HIV since there is not data about screening impacting prostate CA in people living with HIV.
------------------------------
Aliza Norwood
Austin TX
------------------------------
Original Message:
Sent: 05-19-2020 17:18
From: Gina Tomkus
Subject: PSA screening
What is everyone's thoughts on PSA screening for people living with HIV? The USPSTF gives it a grade C and recommends prostate cancer screening should be an individualized decision for men 55 to 69 years of age.The guidelines note that the three most important risk factors for prostate cancer are: older age, African American race, and family history- however I not see anything specialized about HIV.
However there is some evidence that suggests people living with HIV have worse outcomes for prostate cancer: https://jamanetwork.com/journals/jamaoncology/article-abstract/2740690
Does an HIV diagnosis increase your proclivity to ordering a PSA test?
Thanks everyone!
------------------------------
Gina Tomkus, PA-C
San Diego CA
------------------------------