Finally, we are getting a little common sense discussion about the role of PSA screening.
Not to beat a dead horse, but as we all know the United Sates Preventive Task Force (USPTF) changed their rating of the PSA test from a D to a F. The result of this change is that many doctors, especially Family Practice Physicians are no longer providing the screening test to their patients. The current state of affairs is that a man will not be screened for prostate cancer until he is symptomatic. As those of us who have advanced prostate cancer know, when you have symptoms you most likely have developed metastatic prostate cancer (advanced prostate cancer). Metastatic prostate cancer is NOT curable and it is a terminal illness.
So, according to the USPTF we should not bother to screen men until they have an incurable terminable disease! Ok, I give up, where is the logic to this?
The bottom line is that stopping PSA screening could result in many more cases of advanced disease, actually according to a new study as many as 17,000 new cases of advanced prostate cancer each year in the United States alone! this 17,000 number was deduced from an analysis of data from the pre-PSA era.
the USPTF claimed that widespread PSA testing caused significant damage by the over treatment of men with prostate cancer. Just for the sake of clarity, PSA testing does not cause damage, over-treatment (which does happen) is caused by bad advise from over protective and zealous doctors.
“There are trade-offs associated with the PSA test, and many factors influence the disease outcome,” said study researcher Dr. Edward Messing, chairman of urology at the University of Rochester Medical Center. “And yet our data are very clear: not doing the PSA test will result in many men presenting with far more advanced prostate cancer.”
Messing and colleagues reviewed data from the largest cancer registry in the U.S. for the years 1983 to 2008. Prior to 1986, PSA screening in men was not routine.
Based on the incidence of advanced prostate cancer in the mid-1980s, the researchers estimated that there would have been about 25,000 cases of advanced prostate cancer in 2008, had PSA screening not been done. But the actual number was about 8,000 cases, or three times less than expected.
The biggest reduction was seen in cancer cases in older men, particularly in those ages 80 to 85.
Their study was clear, it found only an association, not a cause-effect link between screening and fewer prostate cancer cases. It’s possible factors other than PSA testing were responsible for the decrease in cases of advanced disease, although the researchers took into account participants’ ages and ethnicities, two of the strongest risk factors for prostate cancer.
The researchers also pointed out that finding cancer earlier does not always translate into better survival. But in general, they concluded, PSA testing reduced the incidence of advanced disease.
“The USPSTF will be criticized for not having done analysis such as this,” Dr. Martin Sanda, director of the Prostate Center at Beth Israel Deaconess Medical Center in Boston, said of the study. The sad thing is that the USPTF based their recommendations on one large, but flawed, study, Sanda said.
These findings estimate that there will be about 30,000 more deaths from prostate cancer each year without screening. “Studies like this provide us a window of opportunity to not let that happen,” Sanda said.
Dr. Louis Kavoussi, chairman of urology at North Shore-Long Island Jewish Health System, agreed the main reason for the reduction in advanced cases of prostate cancer is PSA testing.
Yet, PSA testing is not being recommended by many doctors and might not be any longer reimbursed by insurance companies. WhT does this say about our society’s valuation of older men? It reminds me of the practice of sending older people out into the wilderness when society decides that they no longer can make an economic contribution.
A harsh interpretation, I don’t think so.
Joel T Nowak, M.A., M.S.W.