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Prostate Specific Antigen (PSA) Screening
The U.S. Preventative Services Task Force (USPSTF) has released a
recommendation that screening for prostate cancer using a blood test to detect a
man’s level of Prostate Specific Antigen (PSA) should not be done. This
recommendation was made by a volunteer government body composed of primary
care physicians and non-physicians without the input or advice of a single urologist
or oncologist. We at Urology Specialists are concerned that this could cause harm
to many men who would otherwise benefit from early prostate cancer detection.
The USPSTF recommendation was based on its review of data from mainly 2 large
studies, despite some very obvious flaws in study design. More recent reports
using data from within these studies and with longer follow-up of patients (which
is important because prostate cancer is often a slow growing disease) have shown a
reduction in prostate cancer death as high as 44%. The majority of this reduction
in death rates is due to screening and early detection.
In the United States, the rate of dying from prostate cancer has decreased by 40%
and the rate of developing spread of the cancer to other parts of the body (and thus,
incurable) has decreased by 75% since the introduction of PSA testing 20 years
ago. It has been estimated that if PSA screening is not performed, the number of
men every year who are diagnosed with metastatic prostate cancer will, at a
minimum, triple. Clearly, PSA screening has improved the detection of cancers at
an earlier stage when cure is possible.
This is not to say that PSA screening is the right thing for every man. However,
we do not feel it is the government’s right to make the rules as to who can receive
screening and who cannot. This is a tremendous disservice, and potentially fatal,
to men who could otherwise be helped with this test. We believe it is the right of
each patient to have a conversation with their physician about potential benefits as
well as harms and decide whether PSA screening is right for them.
Urology Specialists Physicians