By J. Brantley Thrasher, MD, FACS, Justin M. Albani, MD, FACS, and John C. Hagan III, MD, FACS
Like almost all urologists and most physicians, we disagree completely with the recommendation of the government-funded U.S. Preventive Services Task Force (USPSTF) panel to abandon prostate specific antigen (PSA) screening on men of all ages. Their conclusion is flawed, dangerous and catastrophic for men. If the PSA test is no longer done or no longer paid for by insurance and Medicare many older and middle-aged men will die painfully and prematurely. Doctors and patients cannot let this happen!
The USPSTF does not have a single urologist, oncologist, radiation oncologist or prostate cancer specialist among its ranks. It is chaired by a pediatrician. This task force has previously modified its proposals based on public outcry such as with their controversial breast cancer mammography screening report. By concerted action of the general public these breast cancer screening exams are still available to women. We are asking that MedHelp users join America's urologists and act to stop this flawed PSA recommendation.
The American Urological Association currently has a best practice statement that supports the use of PSA and believes, when used and interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, risk-assessment and monitoring of prostate cancer patients.
Urologists still recommend a discussion between a man and his physician regarding risks and benefits of the PSA test and they stress that a prostate biopsy is a very successful procedure; complications are less than 1 percent. If a prostate cancer diagnosis is made, not all prostate cancers require treatment — active surveillance is a viable option for many men but requires physician counseling.
The USPSTF Evidence Report inaccurately understates the results of the European Screening Trial reviewing the effect of PSA screening on prostate cancer mortality. It is a very large study with seven countries involved and showed a 20 percent reduction in deaths in the PSA-screened men.
The USPSTF Evidence Report down plays this benefit by saying that it comes with a very high complication rate and quoted outdated and unrealistic high complication rates from biopsies and treatment. Throughout the USPSTF report they neglect important published research. A detailed critique of their techniques appears on the following page.
For instance, and unbelievably, the USPSTF ignored many fine medical studies in which almost every country around the world performing PSA screening has seen a decrease in prostate cancer deaths. A study in CA: A Journal for Cancer Clinicians revealed a drop in deaths from prostate cancer of 39 percent in the United States since the year 2000 when widespread PSA screening started.
Until there is a better test for the diagnosis of prostate cancer, PSA is one of our most important and least expensive diagnostic tools. Don't take it away from physicians. PSA remains one of the best cancer tests in the world. Disparaging the PSA test before a suitable alternative is widely available is doing a deadly disservice to millions of men worldwide who may benefit from the early diagnosis of a disease that, once out of the confines of the prostate, is not curable.
We hope this helps clarify some of the issues many prostate cancer experts see as erroneous with the USPSTF recommendation. Please go to the USPSTF website and use the "contact us" link at the bottom of the webpage to voice your objection to taking away the PSA test. Also ask your medical insurance carrier to continue to cover the costs of PSA screening.
Published: December 8, 2011.
J. Brantley Thrasher, MD, FACS, is a professor and William L. Valk chair for the department of urology at the University of Kansas Medical Center in Kansas City, Kansas.
Justin M. Albani, MD, FACS, is a urologist specializing in robotic urologic surgery in Kansas City, Missouri.
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.
Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Medical Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.
This is a summary of the article "Don't Test – Don't Treat: The New Paradigm for the Treatment of Prostate Cancer?" by Justin M. Albani, MD, which was originally published in the November/December 2011 issue of Missiouri Medicine. The full article is available here.
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