Prostate Cancer Screening Decision Should Come from Patient March 4
The American Cancer Society released new guidelines for prostate cancer screening on Wednesday, according to various news reports. Although a report on CNN described the new guidelines as “pretty much like the old guidelines issued in 1997 and 2001,” there is one area that is being emphasized this time around: the importance of laying all the advantages and disadvantages of undergoing a screening in the open before making the decision to undergo the procedure.
Dr. Otis Brawley, chief medical officer of the American Cancer Society, made the following statement: “What we are trying to say to men is the harms (of prostate screening) are better proven than the benefits.”
Prostate cancer detection consists of prostate specific antigen (PSA) screening, a procedure that can detect cancer but can also generate false alarms. These false positives can “lead to unnecessary and uncomfortable biopsies and treatments that carry undesirable side effects such as impotence and urinary incontinence.” At the same time, there are instances when tests that come out as normal do not detect existing cancers.
Hence, the Society suggests that men aged 50 and older who have “no special risk of prostate cancer” work closely with their respective doctors regarding the “pros and cons” of undergoing screening. Patients and doctors should discuss what risks exist and then make an informed decision together on whether undergoing a screening is worth it; the focus, therefore, is on individual counseling, as opposed to a general practice applicable to everyone.
American Society of Clinical Oncology president Dr. Douglas Blaney gave the following statement: “All men considering testing for prostate cancer should be fully informed by their clinicians about their risk factors and other uncertainties before being screened.”
Tags: prostate cancer decision, prostate cancer screening, prostate cancer test
Philip123 Mar 5
First off, prostate cancer is a terrible disease and I commend urologists in their fight and plight against this scourge. That said, the PSA test is not a specific test, it is not a sensitive test. Screening tests are generally given to populations that are mainly without disease, so when there is an error it often falls in the majority group, ie the people without disease, i.e. a false positive result. If there is a positive finding the follow-up test, prostate biopsy is both expensive and poses a not insignificant risk to the patient. If the result was not a false positive their is then no good way to stratify which are the very slow growing prostate cancers which might be addressed with “watchful waiting” versus the more malignant and aggressive types. Finally if one chooses to intervene there is no home run treatment in fact its hard to say whether the treatments are often really of much benefit at all in terms of over all mortality while they carry a significant risk of long term complications. Evidently, two recent studies have now also supported that PSA screening is not of benefit and may actually be harming patients from the unnecessary procedures secondary to false positives.
So likely the PSA test isn’t worth it, which then brings up a related question which may sound flippant but I think is entirely reasonable. Unless you have Dr. Goldfinger, the dreaded finger wave is a worse test than even PSA as a screening test. Is their any rationale reason for a digital rectal exam as a routine urologic screening?
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