The PSA test for prostate cancer, which IMHO, has been a Full Employment Act for Urologists, as well as a sales brochure for daVinci robotic surgery machines, is no longer recommended for any man.
The task force said it conducted a review of clinical studies of PSA testing, including a large U.S. study and a European one. The U.S. study didn't find a mortality benefit. The task force said the European study suggested a small benefit of no more than 1 in 1,000 men screened.Arguing against this test is like arguing against breast cancer screening. That too, has failed to show any true benefit. What we cannot handle intuitively is the false positive problem. Our "better safe than sorry" mentality should be replaced with "worse likely harmed than rarely sorry". Neither popular screening generates any good for the vast majority as well as much harm for way too many.
"Many men are harmed by prostate-cancer screening" with a PSA test, said Michael LeFevre, the task force's co-chairman and a professor at the University of Missouri School of Medicine. "Very few will benefit." The task force is made up of 16 nonfederal, primary-care providers who review preventative health services and make recommendations, primarily for primary-care doctors.
Dr. LeFevre said the task force recommended doctors could still offer the PSA test if men are informed about the risks and benefits of the test. The blood test is meant to detect a substance found normally in the prostate that is also made by cancer cells. Men with higher PSA scores typically have a higher risk of developing prostate cancer. But the test isn't perfect, and in some cases follow-up biopsies find no cancer. [More]
Just say no, amigos.
10 comments:
John,
Your wrong about screening...the problem is not the screening or the biopsy, it's the improper treatment and poorly informed doctors.
I was discovered (through PSA screening) with a small Gleason 3/3 prostate cancer seven years ago by a local doc. He wanted to do an immediate prostatectomy.
I went to Sloan Kettering Cancer Center...put myself under the care of a well-repsected urologic surgeon...and have been on a nutritional treatment with constant screening for seven years.
Without the PSA and biopsies...I would not have known whether my cancer was aggressive or benign.
Sorry, buddy...retract your blog.
Best, hope all is well,
Rick Pace
On the contrary, Rick, perhaps you should retract your comment. While we celebrate the fact that you have not been lost to prostate cancer, your single data point is inconsequential in the face of aggregate data. Moreover, you have no proof that the life you are living now is in any way superior to the one you would be living if you never had the PSA, unless you had other symptoms (that led you to get the PSA) that are now gone. You don't know that the tumor would have progressed, or progressed fast enough to have a detrimental impact to your quality of life or lifespan. Finally, it's great that you have the resources to be able to go to Sloan and get a second opinion, but for many others this isn't an option. Not to mention the fact that for those outside the health industry, knowing whose opinion to trust and not trust is baffling for many. Solving the PSA problem is a far more attainable goal than solving the "access to quality health care" problem.
To anonymous (and I hate anonymous comments),
I most assuredly will not retract my comment.
I've discussed it with numerous folks, including a number of the Sloan doctors. They will tell you time and again how aggressive cancers were detected through routine PSAs (low PSA numbers that diagnosed as very early, very aggressive cancers).
This is a classic example of where research science (and aggregate data) is misleading.
Your reasoning about my personal situation is illogical...and potentially harmful to other men who read it and choose not to do PSA. What if one of them has a very aggressive cancer that is not discovered until they have physical symptoms (which, in many cases with aggressive Gleason 4s, is when the cancer has spread to other tissue and capable of metastasis)? Do you want to live with that?
Rick Pace
508-813-6246 Cell
Rick,
Your example only underlies the illogical nature of your objection. "What if ONE of them"???? How many thousands of unneeded prostate surgeries are needed to balance your case of the person with the aggressive cancer? From your emotional reaction I would imagine there is no limit (and somewhere doctors and pharmacists and jumping for joy at your bias). The reality is that there is a limit. The aggregate data from the cited study is showing that there is more net harm than good coming from our reliance on PSA. There are always going to exceptions, and that sucks. But the volume of unnecessary surgeries (and the complications that can come from that) sucks worse.
Thousands of people die every year from drunk driving accidents. Do you believe we should require automakers to install mandatory breathalizer-ignition switches on all cars? It would be a incomplete solution (people could have somebody else blow into it), malfunctioning units would be a hassle rendering cars inoperable until they were fixed, and it would overall be a headache and result in a reduction in utility for society as a whole. I believe that you would argue "Who cares, as long as it saves some lives?" I bet people who have had a loved one killed or injured by drunk driving might agree, but that is because their emotional involvement does not allow them to accept the logic that this approach might cause more harm than good. Just like how your experience with prostate cancer colors your view of this situation. Unless you have reason to show otherwise, I'm guessing the research scientists involved in the study are far less liked to be biased on this topic than you.
- the hated Anonymous
John,
Is it possible to encourage this person to disclose their identity? I'll continue to follow this chain for a bit....would be glad to arrange a conference call with the folks at Sloan to discuss his position.
People who make judgments behind curtains have no standing.
Thanks so much and hope things go well on the farm.
Regards,
Rick Pace
508-813-6246 Cell
All:
I'm not sure what is up with the comments, or if there is just a delay. There is a spam filter, but I haven't deleted any comments. Sometimes Blogger has its own mysterious ways.
If your comment hasn't shown up (and some are on the home page, but not here as I write, it should show up eventually. Or you can e-mail it to me and I'll try to post it.
Re: the question at hand. I realize this topic stirs strong emotions especially for those with first-hand experiences, but try to keep in mind the vastly larger number of men who struggle with unwarranted side-effects for no good reason other than excessive precaution. As all have said, we are happy for you survivors, but critics of PSA testing should be answered not by individual but overall evidence, IMHO.
FWIW, refusing the PSA is not a pleasant conversation right now with your doctor, but I think more primary care physicians will move that direction.
Above all, the important question with our dysfunctional health system, is: What will your insurance company decide to do with this recommendation? We've constructed a system that adds an actuary to the table.
Comment added from my e-mail copy:
Anonymous:
Rick,
I agree with you. Six years ago My cancer was discovered by elevated numbers on my second PSA when I was 51. I said no to the biopsy and tried alternative treatments which gave a "false" lower PSA. Three months later with another elevated PSA number I agreed to the biopsy (Gleasen 4/4). I elected for surgery after extensive research and prayer. Result: Gleasen score of 9/9 after surgery. My cancer was agressive. Had I waited another month it would have matastasized. Maybe I was the 1 in 1000 but I am thankful for the PSA and three insistant Drs.
BTW I did the nerve sparing DaVincy surgery and it was as they claimed. I don't even need the little blue pill.
Comment added from my e-mail:
Anonymous:
John,
I just tried to leave a post on here that supported Ricks case by my own experience with cancer and it got knocked off. Why?
(See my above lame explanation)
John,
I appreciate your follow up. Sadly, you miss the point. As one of your comments related, with intelligent doctors it can save your life. I'm afraid men will 'throw out the baby with the bathwater'..not perform a potential informative test because doctors have enormously over-treated non-aggressive prostate cancers.
Yes, the American healthcare system is a byzantine disaster that makes some folks wealthy at the expense of the health of the citizenry (and by the way, to respond to anonymous accusations of my liberal, progressive bent...I'd call it more southern social conservatism...but I dislike political labels just about as much as anonymous comments).
I sincerely think you are 'buying in' on a poorly thought medical research conclusion.
Hope you are enjoying the holiday.
Best for now,
Rick Pace
508-813-6246 Cell
PS Can you delete the option to make anonymous comments? I think it lessens the integrity of the Blog. I actually need to check our blog also.
All:
There are still comment issues so here's another response from anon:
Rick,
How exactly do you propose to make all doctors "intelligent" regarding the PSA? The incentives for doctors to know what they are doing are no different now than they have ever been. What new idea do you have to fix that problem? Until fixed, the research shows that the PSA creates more harm than good. This is the reality, unless you have data to show that the studies were somehow in error.
Regarding your dislike of anonymous commenting, you may as well just say "I hate the internet". Anonymity is the societal norm of the online community, at least in countries that believe in free speech. If John did remove the option for anonymous commenting, couldn't I just make a fake Google account and comment under it? In fact, I actually did that, but the comment got swallowed by the Blogger monster (as did this one until I decided to email it to John). I declined to repost, for after rereading it, I found it a bit too caustic, and John already cut to the bottom line in his responses to you anyway. On the upside you do have some who share your view of internet freedom: http://online.wsj.com/article/SB10001424052970204643804577101522579231922.html
My name makes no difference when it comes to the relevance of my opinions and arguments. If you are unable to accept the opinions of others unless you know their names, that is a problem for you to address, not for the rest of us. I'm guessing that you're looking to see if there is any way I have any personal experience with prostate cancer or PSA tests, because only then would my opinion have real weight. If so, that would only underscore your bias towards anecdotal evidence, and away from the rational non-partisan science.
- Anonymous (the commenter, not the anarchist hacker group)
Back to me:
Anonymity is not a convenient dodge for blog commenters, it is essential to present arguments devoid of "source pollution". While this advantage is spoiled by trolls, that is clearly not the case here.
At any rate, I welcome anonymous commenters.
John
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