I heard on the news tonight a well known urologist expressing “outrage” at the findings of the task force. No doubt it is in other newscasts as well, but I can only stand to listen to so many… Let’s start by giving you the link to their recommendation which is here. My personal view is that the better recommendation would have been to have men read the document before deciding about being screened, and then make their own decision. I can’t tell you how many times I have had men read a clinical trial (which must explain in 8th grade language, the risks and benefits) consent form and then decline to participate because of the long list of side effects that accompany every drug imaginable. However in the case of PSA testing, these side effect considerations are outweighed by 2 decades of “promoting” screening by well-meaning (and some not-so-well meaning) physicians, often urologists. It is likely these doctors are biased, not because of any personal gain, but because they are on the front line of watching men die from prostate cancer and our long-standing belief is that early detection is the way to cure cancer. We all grew up in the era when Pap smears helped eliminate cervical cancer, and now we have a vaccine that can do even better.
In addition, I have virtually never met a man in my clinic or in our support group who didn’t feel either that 1) screening and treatment saved his life, or 2) that earlier detection/screening WOULD HAVE saved his life. The reality is that neither of these feelings is accurate. Some men who are screened will be treated, suffer the side effects, and never would have needed to know they had cancer. Others will be found “early” yet succumb to cancer that had escaped their prostate long before they were detected by the best techniques. And remember that those of us who have lived through the treatment have a built in emotional bias to think “we did the right thing” as a balm for the side effects we endure. In any event, this won’t be the last of this controversy, so we all have time to ponder the challenges of our “favorite” disease. Personally I applaud the USPSTF for taking a hard look at the evidence and putting it together in a document for all to see, and perhaps that document provides the best way to try and help men be better informed than having a political figure, war hero, or movie star stand before the general public and urge everyone to “get screened”.