They got it wrong again – Reader Voices

While prostate cancer is still the second leading cause of death for American men, early detection and advanced treatments have combined to reduce the mortality rate from prostate cancer by nearly 40 percent in the last two decades. During that same time period, we have seen dramatically less metastatic disease than in my earliest days of treating men with prostate cancer in New Jersey 25 years ago before the PSA screening era.

via They got it wrong again – Reader Voices.

This editorial was written by a colleague of mine at Garden State Urology in response to the USPSTF Final Recommendation on PSA Screening states that men should not receive PSA testing.

As a urologist who deals with prostate cancer on a regular basis, this is an extremely disappointing recommendation.  The issue will remain in the forefront of health care debates in the months and years to come.

Urologists Condemn Task Forces Anti-PSA Testing Stance

The U.S. Preventive Services Task Force (USPSTF) on May 21 released its final recommendations on PSA-based screening forprostate cancer (PCa), which advises against the practice and gives it a grade D rating, meaning the task force believes there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefit.”

Since the introduction of PSA screening in the United States, the PCa death rate has decreased by more than 40% and the percentage of men who have distant metastases and incurable disease at the time of diagnosis has decreased by 75%. In addition, he noted that statistical teams at the National Institute of Health concluded that up to 70% of these results are attributable directly to PSA testing.“We think that men should be made aware and offered an opportunity to make an informed decision for themselves,” Dr. Catalona said. “The PSA test provides very powerful predictive information about a mans risk for prostate cancer.”

via Urologists Condemn Task Forces Anti-PSA Testing Stance – Renal and Urology News.

The government has recently issued a recommendation against prostate cancer screening.   The panel that issues this recommendation did not have a single urologist, radiation oncologist, or medical oncologist on the panel.

I agree with some of the conclusions of the task force that men often undergo negative prostate biopsies, which have a risk of infection and bleeding and are uncomfortable.  Negative biopsies cause anxiety without a cancer diagnosis.  It is also true that men are sometimes treated for cancers that may never cause them symptoms.

The benefits of screening were not given significant consideration.  Prostate cancer still kills men and screening does save lives.  Metastatic prostate cancer causes significant pain and its treatment, hormonal therapy causes long term side effects such as osteoporosis and decreases quality of life.

The other change has been the decreasing morbidity to treat prostate cancer.  Most men that have early stage prostate cancer are cured with surgery, but most of them have full return of urinary function.  The advantage of having surgery are a decrease in long term BPH (benign prostate growth) symptoms.  As men get older, they have increasing frequency, nocturia (urinating at night), slowing stream, and a hesitancy (difficulty in starting to urinate).  After surgery, men have a strong stream that does not change as they age.  The morbidity that panel looked at from treatment was worse than patients would face today.