PSA Decision Could Be Deadly
A draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older goes too far, says Gerald Andriole, the principal investigator of the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial, argues that it would be a mistake to universally dismiss the PSA test.
Discouraging men with a high risk of dying from prostate cancer – particularly African-Americans and those with a family history of prostate cancer – from getting a PSA test would be misguided, he adds.
For men who choose to have a PSA test, Andriole urges caution if the test is abnormal. Doctors, he says, often do not need to rush to perform biopsies or recommend aggressive treatments because most prostate tumors grow slowly. In many cases, “active surveillance” may be practical, which involves periodic PSA tests and biopsies to monitor tumor growth rather than opting for immediate aggressive treatment.
Ending PSA screening all together would mean a return to the “pre-PSA” era when about a third of prostate cancers were advanced and incurable at the time of diagnosis.
There always has been controversy about whether PSA tests were life-saving or a waste of time. Most preventive medical screenings are a waste of time if the truth be known. Prevention, on the other hand, is good but that requires willpower to diet, exercise and maintain a healthy life.
Most prostate cancer is so slow growing that you will ultimately die with the disease rather than die of the disease.
Individuals, not the government, should decide whether any given test is a waste of time or money.
USPSTF is not the government, it’s an advisory body made up of medical practitioners. Its recommendations are not binding on insurers or individual behavior. Of course, none of this would be clear from Gingrich’s idiotic rant last night, but this is what our political discourse has come to.
Gerald Andriole makes a fallacious argument. He states, “about a third of prostate cancers were advanced and incurable at the time of diagnosis.”
But, to determine if one has prostate cancer, and advanced prostate cancer, the patient has to undergo a test.
Andriole fails to discuss and consider the total number of male patients who undergo tests, including biopsies, and do not have prostate cancer, or advanced prostate cancer, or who are wrongfully diagnosed as having prostate cancer, or prostate cancer that will grow into advanced prostate cancer.
When the total population of men is looked at prospectively, many men received testing and treatment who did not need testing or treatment because of misdiagnosis or because the cancer was very slow growing and patient will not die or have bad consequences from the cancer. The harm to those who were unnecessarily subject to further testing and treatment was great enough to undo the benefits of the few who benefited from treatment.
The harm to the general male population was too great to justify prostate cancer testing and that is why the policy was changed. To talk only about those who already have advanced cancer, leaves out the population that did not need testing, was misdiagnosed, did not benefit from the treatment or was harmed by the testing and unnecessary medical procedures.
Andriole merely points out that there is evidence from randomized studies suggesting that certain groups of men–mainly younger men and those of African-American descent–do benefit from the PSA test. Apparently it does identify prostate cancer at an earlier stage when it is more likely to respond to treatment. Younger men with high grade and locally advanced prostate cancer at the time of diagnosis have a poorer prognosis. It is also possible that one needs a long follow up, say 12 years at age 55, to detect gains from screening.
Arguing that the test shouldn’t be recommended for people who might gain from it because more people would not is like eliminating mammograms for women because it is too expensive to test the whole population.
If we didn’t have ObamaCare, the USPSTF could go back to making recommendations based on medical benefit and individuals could go back to deciding whether the test is worth the price the people who do it are asking. And they could decide, in concert with their physician, whether to do a biopsy or follow the cancer with PSA monitoring.
This debate is following exactly the same steps as HRT replacement in women. Overlooking groups that benefit in order to end testing that is thought to be “too expensive” for the population even though it reduces the risk for some individuals.