If you have been following the news in the last week, you will see that the United States Preventive Services Task Force (USPSTF) has recommended that doctors not routinely screen for prostate cancer in men. A separate and independent review panel agrees with this recommendation.Mind you, both groups are composed of doctors and analysts who have no ties to government employment or drug companies. Also, their recommendations are based on how well screening and preventive efforts work without regard to their cost. In other words, recommendations are not made on the basis of cost to the system or rationing.
PSA blood testing and rectal examination have to some extent seemed to doctors to be tools that are not the "sharpest tools in the shed", but the only tools available. It was hoped that over time, their use in screening for prostate cancer would have a positive impact on outcomes; that is, keep men from dying of prostate cancer.
The problem here, is that these tests do not seem to end up saving lives. In fact, it may be that they cause more anxiety, suffering and painful and unnecessary tests and surgeries than benefits.
A major difficulty here is that prostate cancer is common, yet dying of it is not.
Cancer cells start to appear in a normal, healthy man's prostate gland as a pure correlate of aging. By the time you are 50 years old, the chance of having cancer cells in your prostate gland is 50%. At 65 years old, the chance is 60% and by 75 years old it is 75%.
Yet, out of 17 men with cancer cells in their prostate, only one will die. The other 16 will go on to die of natural causes or other conditions without any sign of prostate cancer.
The problem is, that we do not have a way of determining who is that 1 guy out of the 17, so we end up treating all of them as if they will go on to die of prostate cancer without treatment.I
In addition to this not very good statistic, the number of men every year who die of prostate cancer is staying the same over time. In other words, we are not saving lives by doing routine annual rectal exams and PSA blood tests.
Faced with this, it seems that it would be better if we simply stopped doing such routine screening until we can develop a way to determine who's prostate cancer should be aggressively treated, and who's can simply be watched.
Mind you, this does not apply where there are symptoms present that raise a concern of prostate cancer- that's not screening, it's diagnosis. It also may not apply to men with a concerning family history of prostate cancer in their fathers or brothers.
This is certainly a discussion that can be had face to face in the office. I just think patients should have all the information at hand to make decisions that they feel are right for them.
For my part, being a man over 50 with no history of prostate cancer in my family, I do not intend to have prostate cancer screening tests done as part of my annual physicals.
