"The groundwork of all happiness is health." - Leigh Hunt

PSA screening for prostate cancer: the physician's perspective

Yesterday's announcement that men mustn't undergo routine PSA tests to screen for latent prostate cancer is certain to stir controversy for months to return. I consider the US Preventive Services Task Force (USPSTF) made the proper decision, and I appreciate the way it reached its conclusion.

On the surface, rejecting the usage of an easy blood test that may detect cancer at an early and treatable stage. Cynics have been saying it's the work of a bunch more concerned about rationing and cutting health care costs than health. The decision is smart, not silly, and can improve men's health, not harm it.

The word “cancer” often conjures up images of rapidly growing clusters of cells that, without aggressive treatment, will invade other parts of the body, harm health, and possibly kill. will This actually explains many cancers. But not most prostate cancers. Most of the time, prostate cancer is indolent. It grows slowly and is confined to the prostate gland, with many men never knowing the cancer is present throughout their lives. These slow-growing prostate cancers cause no symptoms and never threaten health or longevity. This implies that many men with prostate “cancer” never need treatment.

Before the arrival of PSA testing within the Nineties, some men learned they'd prostate cancer due to symptoms similar to difficulty urinating or persistent pain within the pelvic area. Others are diagnosed when a physician examines the rectum and notices suspicious spots on the prostate. These digital rectal exams remain a vital a part of a person's physical exam because they will discover what are called clinically detectable cancers, for which treatment should still be helpful.

A high PSA level is a strategy to signal other tests, similar to a biopsy, that may tell if cancer cells are present. Unfortunately, it cannot tell the difference between a malignant cancer that requires treatment and one that doesn't. For this reason, most men who've a PSA and a biopsy that shows cancer cells within the prostate select surgery or radiation therapy. Many of them don't require treatment, though, they usually have uncomfortable side effects similar to impotence, incontinence, and rectal bleeding.

Evidence-based decision making

The USPSTF is comprised of volunteers from quite a lot of disciplines, including internal medicine, family medicine, behavioral health, and preventive medicine. No one has a financial interest within the test or treatment.

The task force based its recommendations about PSA screening on many studies, but the first focus was on two key randomized clinical trials, the gold standard of clinical evidence. one, held in Europe, Follow-up was 11 years, which is unusually long for clinical trials. It compared the health outcomes of men who were offered PSA screening with those of men who weren't offered a PSA test. The panel checked out clear, measurable endpoints similar to death, death from prostate cancer, and rates of infection, impotence, incontinence, and other downsides of prostate cancer diagnosis and treatment.

The consequence that mattered most—death—made no difference. Overall Mortality amongst men who did and didn't undergo PSA testing, although prostate cancer mortality decreased barely over 11 years within the screened population. The researchers calculated that to forestall one death from prostate cancer, 1,410 men would should be tested, and 48 additional cases of prostate cancer would should be treated. PSA-based screening barely reduced prostate cancer mortality, “but was associated with a higher risk of overdiagnosis,” the authors concluded.

The second case was based within the United States. Prostate, Lung, Colorectal, and Ovarian Screening Trial. After 13 years of follow-up, the general death rate from prostate cancer was 3.7 deaths per 10,000 person-years within the PSA screening group and three.4 deaths per 10,000 person-years within the control group. Again, no difference. In contrast to the European study, and consistent with the practice of drugs because it is currently practiced here within the United States, there was no difference in prostate cancer mortality within the screened group in comparison with controls.

All trials have flaws, and Proponents of PSA screening states that these flaws undermine the USPSTF's suggestion. Had these flaws not existed, they are saying, the outcomes would have supported the advantages of screening. This allegation has not been proven. In addition, critics base their arguments on the outcomes of only two countries within the European study, which had higher results than the opposite five.

Moving forward.

For years, I actually have counseled my patients in regards to the uncertainty of routine PSA testing, and more importantly, the uncertainty of their treatment once prostate cancer is diagnosed.

Many of my patients have chosen to treat their prostate cancer. These decisions were made before we knew what we do now about PSA testing and subsequent treatment of PSA-detected prostate cancer.

Going forward, deciding whether or not to begin treatment immediately within the event of a cancer diagnosis is step one in getting a PSA test, a procedure advisable by the USPSTF. will vary greatly based on For my patients who proceed to want the test, I ensure that they know that PSA testing can detect prostate cancer early, but many cancers are harmless.

New tests under development may in the future find a way to inform a benign from a dangerous prostate cancer. Meanwhile, as I explained in a Recent Scientific American topicthe practice of drugs should reflect what current studies show, and our decisions ought to be based on evidence, not only our beliefs.