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Many Doctors Plan to Keep Screening PSA

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The U.S. Preventive Services Task Force recently recommended that doctors drop routine PSA screening for prostate cancer. This decision was based on large, long-term, prospective trials that showed PSA screening did not improve overall survival. But a new survey from Johns Hopkins shows that many primary care physicians are reluctant to follow the recommendation. Three fourths of these doctors say their patients expect annual PSA tests. Although most doctors now believe in the concept of evidence-based medicine, only 2% said they would change their practice to omit routine PSA screening.

[Cancer, online, April 19, 2012]

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It is hard for the general public to grasp the idea that finding very early cancers when one is otherwise asymptomatic can be counterproductive and lead to therapies which cause more harm than good. People cannot grasp that some cancers spontaneously disappear.

The Hopkins study would have been more useful if it asked about whether doctors were adjusting their protocols based on the age of the patient since the "benefits" of the test goes down as the patient gets older. Most post 80 year old men who die have prostate cancer and it never affected their life. Treatment can lead to impotence and incontinence.

If you have symptoms or "feel" something, see a doctor. Otherwise, educate yourself and decide whether PSA testing is right for you.

Looks like real doctors in practice have more common sense than bureaucrats. Since one of the common symptoms of PCa is -- no symptoms -- PSA screening is an inexpensive and noninvasive way to detect its presence. The problem is, and always has been, that screening detects cancers that may not develop to the point where they require treatment, but many patients and doctors will elect to treat anyway.

If the treatment chosen were free of adverse side effects, this would only be a waste of money. However, the "gold standard" -- surgery -- is fraught with nasty side effects, so the outcome may in fact be worse than living with a slow-moving disease.

The way forward will include 1) prevention, 2) better techniques to determine PCa aggressiveness, and 3) elimination of adverse treatment side effects. Progress is well along in all these areas, so now would be a bad time to stick our heads in the sand and wait for treatment until the disease has progressed to where it's dangerously symptomatic and treatment is ineffective or worse.

More care doesn't mean better care. Thank goodness the US Preventive Health Task Force recommends dropping routine PSA tests. Dr. Otis W. Brawley, chief medical and science officer of the American Cancer Society and its executive vice president and author of How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, as well as Dr. Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and author of Overdiagnosed: Making People Sick in the Pursuit of Health make solid points about the misuse of certain screening tests. In Welsh's words Doctors need to not "... feel compelled to end every patient encounter with an order for a test, a recommendation for a procedure or a prescription for a medication.”

In 1999 when I was 59 I was diagnosed through a PSA test to have prostate cancer. Per the biopsy, my cancer was diagnosed to be an aggressive cell type, and based upon the information given to me by my dr. I chose to have surgery. My outcome for removing the cancer per the pathologist report was good as the cancer was close to but had not reached the prostrate membrane outer wall. The lymph and seminal glands were clear.

That was the good news, the bad news, is that since the surgery, I suffer from a light incontinence and erectile dysfunction. If I were to have to make the same choice now 13 years later, I would make the same choice. So I do not see how men with aggressive PC will be diagnosed if PSA testing is discontinued.

I am one of three brothers from the same familly all have had prostate cancer . The youngest was diagnosed with prostate cancer some 12 years ago at age 65 - too late as it had already spread. He never went to the doctor or had PSA. He just died at age 77 after fighting the cancer for some 12 years. I was diagnosed in 2005 at age 78 with prostate cancer after a PSA indicated that I had shown increase in the PSA count. I also had a prostate exam which indicated a lump on my prostate. I had a biopsy that showed an aggressive style of cancer.

I had 25 external beam radiation treatment, luprom hormone injections and then a radioactive seed implant, all under the supervision of H Lee Moffit cancer Center in Tampa and Lakeland, Fl. I am 85 years old and cancer free as I write this after 7 years. My other brother was diagnosed with prostate cancer last year at age 81 (2011) and has undergone external beam radiation treatment in Kansas City. He is 82 years old now. At his age they do not plan any further treatment. I am in favor of continuing the PSA diagnosis.

Although studies show that PSA screening doesn't really give specific results for PC patients but still somehow helps men to monitor their PSA level so that they can be more conscious about there health and prevent whatever the risk of acquiring this disease then I don't think this should be stop.

For me it should be the prerogative of the patient if he wants to do the PSA screening or not, that is the patient's right. We get to choose what we think is helpful and best for us.

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