THE VIEW FROM THE OFFICE
The United States Preventive Services Task Force (USPSTF)
Will Advise Against Routine Prostate Cancer Screening
The U.S. Preventive Services Task Force has concluded that healthy men should not undergo routine prostate-specific antigen (PSA) testing, the Will Advise Against Routine Prostate Cancer Screening
The recommendation, which will be made available for public comment next week, was based on an analysis of five trials and applies to men of all ages. The Times quotes the task force's chairwoman: "Unfortunately, the evidence now shows that this test does not save men's lives ... This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime."
In 2008, the USPSTF recommended against PSA testing in men aged 75 or older, and said evidence was insufficient to recommend for or against testing in younger men.
Read the full story in the New York Times here.
http://www.nytimes.com/2011/10/07/health/07prostate.html?_r=1&scp=3&sq=prostate%20cancer&st=cse
As Jerome Groupman says in his new book ("Your Medical Mind"), to make a reasonable decision on screening, you have to look at the numbers. "Prostate cancer is slow-moving; more people die with it than from it. According to one 2004 study, for every 48 prostate surgeries performed, only 1 patient benefits--the other 47 patients would have lived just as long without surgery...Moreover, the 47 who didn't need the surgery are often left with an array of unpleasant and irreversible side effects, including incontinence, impotence and loss of sexual desire. The likelihood of one of these side effects is over 50%--24 of our 47 will have at least one. This means a patient is 24 times more likely to experience the side effect than the cure...Returning to prostate surgery, consider that 6 weeks is the advised recovery period. Coincidentally, the operation will, on average, add 6 weeks to your life. (This averages across the 47 people who had no benefit from the operation and the one person who did.) To my way of thinking, the decision then becomes this: When do you want to 'spend' those 6 weeks? When you're relatively young and feeling well, or at the end of your life, when you're old and only dimly aware of your surroundings?"*
* Quotation taken from the Daniel Levitin, "Heal Thyself," New York Times Book Review, Sunday, October 9, 2011, pp28-29.
COMMENT: As I have previously reported, I do not recommend this test and do not get it for myself. The test cannot tell which men will have a problem with their prostate cancer and which will not. This is the only information we really want to know. There are new tests under development, maybe one of them will provide a better option. I have already had patients asking me about the new urine test for prostate cancer, which is still in the research phase and is not yet commercially available. Another link to information on this test can be found here.
This being the best data we have, will nevertheless arouse a strong push back. This is happening now with USPSTF screening mammography guidelines. The Family Practice News presents an article on the front page which is an analysis of data from breast cancer registry (very weak type of study), where they found a large percentage of cancers were detected by self-palpation, and also for women under 50 , 48% detected by mammography. This is presented as evidence to do BSE and mammo in women <50. What is at best a weak and easily refutable hypothesis (until proven otherwise by real data), is presented as a viable conclusion. There is no mention that finding a mass incidentally is different from performing BSE systematically; or that the fact that cancers were found in women <40 by a mammogram does not mean we made them live better or longer compared to women who were not screened.
ReplyDeleteSigh... but this time with some hope. Thumbs up to USPSTF.
Oleg Reznik, MD
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