PSA and the US Preventive Services Task Force

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”.

6 Comments

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6 responses to “PSA and the US Preventive Services Task Force

  1. Joe Blue

    Isn’t whether or not to get tested the wrong question? Information is good. Shouldn’t the focus be on advising men what to do when they get the result?

    • I would agree with that approach in some ways, and it is certainly one the urology community promotes. However, I have yet to meet a man who doesn’t have a significant decrement in quality of life (increased anxiety) by knowing his psa is going up or that he has a low grade cancer and now must be on “active surveillance” at a minimum. Remember that prior to 1990 and the PSA test, the number of men dying of prostate cancer wasn’t all that different from today, but we were diagnosing probably only half the number of men. That other half did fine, thank you very much, without knowing ANYTHING about their PSA. There are those who feel we would be seeing many more PCa deaths now if it were not for screening. Possibly true, but it still doesn’t allow us to weigh the unnecessary diagnosis/treatment morbidity in any meaningful way.

  2. Bob Lederer

    Totally agree. What can be done to educate urologists? They see every patient first and they get first shot at them. I will bet the training programs for new urologists have not changed at all. It is a big source of revenue.

  3. John H. Melby

    I disagree with the recent goverment report on early PSA screening. If my PC was not detected and treated early my agressive form of PC would have killed me by now. A Gleason score of 9 is has to be treated ASAP, yet I had no symptoms. The early screening picked it up when my PSA went from 3 to 9. Once the diagnosis is made let the patient decide what to do but let’s keep screening!!!!

  4. Craig Becker

    I have heard the many sides of this story from men in my PCa support group. I know of multiple men who had a routine PSA screening and found a PSA level of 10 or above and had a RP operation, (after biopsy). Today their PSA is undetectable. I know multiple men who waited too long to get a PSA test and once performed, found their PSA in the hundreds. They are no longer with us! Over treating a PCa man has been and will always be a hot topic of discussion. Here’s my point, prostate cancer is the 2nd leading cause of death in men. PSA testing is the only test we have to detect the 2nd leading cause of death! Furthermore, we have no way to determine the agressiveness of ones’ PCa which could determine the amount and direction for treatment. Until we can determine “agressiveness” of PCa, I feel it’s absurd to lessen PSA screening.

    • Thanks for the feedback. I want to correct one thing in the above comment from Craig. Prostate cancer is NOT the 2nd leading cause of death in men. In fact, your chances of dying from prostate cancer are 1/36 or about 3%. Cancer IS the second leading cause of death in men, and prostate cancer IS second on that list to lung cancer.
      But when you add all the other types of cancer, you are still at “only” one in 4 of dying of some kind of cancer. Another 1/4 of us die of heart disease, From there, the risk is 7% from injuries, 5% from COPD, 4% from stroke, 3% from diabetes etc. The CDC website for this information is here: http://www.cdc.gov/men/lcod/2007/index.htm
      In short, it seems we have all inherited a lethal disease called “life”. Let’s enjoy every minute of it and leave the world a better place with whatever time we are given. Craig is doing just that!

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