Published in Missouri Medicine, the journal of the Missouri State Medical Association, November/December 2011
My paternal Uncle Ray and maternal Uncle Tom were tough World War II combat veterans. Both died painfully from metastatic prostate cancer. They were old school and didn't go to physicians unless my aunts put them in a car and drove them to the office. Early and regular PSA screening may have lead to an earlier diagnosis and a later, less painful death.
The current generation of Hagan males over 40 have regular prostate exams and PSA screenings. In his mid 50's, one of my cousins was found to have accelerating PSA readings. He was worked up, found to have a high Gleason prostate cancer and, after careful counseling of his options by his urologist and a radiation oncologist, opted for a radical nerve sparing prostatectomy. Six years later he's doing well with no sign of reoccurrence. The PSA test, costing as little as $70, saved his life. Sounds like a bargain to me but not to the USPSTF.
Because of family history, I am at high risk for prostate cancer. There is no happier day each year than when my PSA comes back less than 1.0 and prostate exam shows only stable asymptomatic hypertrophy. In my 60's, I'm awash in an epidemic of prostate cancer among friends and relatives. I can name 10 male friends that have had their prostate cancers diagnosed by PSA screening. The last funeral I went to was a death at 62 from metastatic prostate cancer in a neighbor.
I am stunned and angered at the USPSTF panel recommendation that PSA screening no longer be done on any male. There are no prostate cancer experts on this government sponsored (and influenced) panel. The committee chair is a pediatrician. This group of pseudo-experts' last recommendation would dramatically cut back breast cancer screening mammograms. There are no breast cancer experts on this panel. Small comfort they are gender blind when it comes to really bad screening conclusions. The USPSTF committee is undoubtedly under pressure from government and insurance industry to reduce health care costs by cutting back on screenings. These deeply flawed recommendations if adopted will create huge male life wastage.
So what is it with this dysfunctional panel? Don't know? Or don't care? In either case USPSTF with its healthcare rationing agenda has created a horrific PSA recommendation.
John C. Hagan III, MD, FACS, is the editor of Missouri Medicine, the Journal of the Missouri State Medical Association, and an ophthalmologist in private practice in Kansas City. Dr. Hagan also answers questions on MedHelp's eye care expert forum.