The Prostate Controversy
Another new controversy in medicine has reared its head. Is PSA screening for prostate cancer really worth it?
Prostate cancer is diagnosed in more than 218,000 U.S. men of which about 28,000 die of it.
This makes it the most common cancer and second-leading cancer killer among men.
In a new report published in the Annals of Internal Medicine the results conclude that the testing leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men
A panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and that the potential harm clearly outweighs any benefits for men age 75 and older.
This 16-member U.S. Preventive Services Task Force published the new guidelines and felt with sufficient certainty that the risk of being harmed exceeded the potential benefits starting at age 75
More and more studies are confirming that just doing more tests, using more drugs and performing more procedures is only driving up health-care costs and exposing patients to the risks of unneeded treatment.
The thought process in the United States that more is always better, and if a test is available we should use it, is being questioned.
This recent guideline is very contentious but is being praised by the National Cancer Institute and the American Cancer Society while being criticized by several Urological groups and physicians.
Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary procedures and surgical biopsies to make a definitive diagnosis?
Since the task force issued its previous recommendations in 2002, at least eight new studies have been published and among them was a large Swedish review that found that men age 65 and older who were treated for prostate cancer were no more likely to survive than those who were not.
Other studies have noted that prostate cancer death rates have plummeted in many countries after they instituted widespread PSA screening.
Setting an age cutoff remains controversial among many groups and patients should be evaluated individually; but insurance companies need some guidelines to avoid paying.
Two large studies are underway in the United States and in Europe to answer the question of whether screening reduces mortality.
Until then, the controversy lingers on and hospitals such as Floyd that offers the free yearly screening with more than 800 participants will have to make their own decision.
Prostate cancer is diagnosed in more than 218,000 U.S. men of which about 28,000 die of it.
This makes it the most common cancer and second-leading cancer killer among men.
In a new report published in the Annals of Internal Medicine the results conclude that the testing leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men
A panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and that the potential harm clearly outweighs any benefits for men age 75 and older.
This 16-member U.S. Preventive Services Task Force published the new guidelines and felt with sufficient certainty that the risk of being harmed exceeded the potential benefits starting at age 75
More and more studies are confirming that just doing more tests, using more drugs and performing more procedures is only driving up health-care costs and exposing patients to the risks of unneeded treatment.
The thought process in the United States that more is always better, and if a test is available we should use it, is being questioned.
This recent guideline is very contentious but is being praised by the National Cancer Institute and the American Cancer Society while being criticized by several Urological groups and physicians.
Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary procedures and surgical biopsies to make a definitive diagnosis?
Since the task force issued its previous recommendations in 2002, at least eight new studies have been published and among them was a large Swedish review that found that men age 65 and older who were treated for prostate cancer were no more likely to survive than those who were not.
Other studies have noted that prostate cancer death rates have plummeted in many countries after they instituted widespread PSA screening.
Setting an age cutoff remains controversial among many groups and patients should be evaluated individually; but insurance companies need some guidelines to avoid paying.
Two large studies are underway in the United States and in Europe to answer the question of whether screening reduces mortality.
Until then, the controversy lingers on and hospitals such as Floyd that offers the free yearly screening with more than 800 participants will have to make their own decision.
posted by Anonymous at 5:50 AM
1 Comments:
I gather that prostate cancer tends to be more aggressive in men who have it before the age of 65. So I think PSAs before that age make sense. Now I had a PSA of 16 once, years ago, when I had a prostate infection. This was after a week and a half of ciprofloxin, so I was referred to a urologist (the initial PSA was 12). Fortunately, a DRE indicated no tumor, and my PSA dropped to 1.1 after three months. My urologist recommended that I have an annual PSA, so that if this sort thing happens again, it will be clear to a physician that it is unlikely to be cancer.
An acquaintance of mine, a fellow of about 60, had a rather different experience. He had an infection, and an elevated PSA (8 or 9, if memory serves), but the PSA failed to drop when the infection resolved. Indeed, he had cancer. He opted for a prostatectomy, and his PSA remains at undetectable levels a year or more later.
Of course, two anecdotes is no substitute for evidence-based medicine!
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