Thursday May 2, 2013
I am a proud member of the American College of Physicians (ACP) and was greatly honored to be made a Fellow a few years ago. But, I disagree, in part, with a major pronouncement from them regarding PSA testing guidelines.
The ACP recommends doing NOT doing any PSA measurements in males either < 40 or > 69. Their arguments, in short, are virtually no one less than 40 gets prostate cancer and beyond age 70, the data show treatment (of any kind) and non-treatment yield approximately the same outcomes, therefore identifyng something which treatment doesn't benefit is a waste of time and money.
They further state that for males 41 - 69, before testing their PSA I should inform them "a male's chances of being harmed are much greater than his chances of benefitting from the PSA test..."
I think all these recommendations make some assumptions I just don't buy into.
First of all, I don't think all patients are created equally. By that I mean, some are at high risk (blacks, persons with [+] family history of prostate cancer, etc.) and should definitely be screened regularly with a PSA blood test. Many 75 year old patients are in otherwise marvelous health and, if, indeed, they were found to have prostate cancer, might well opt for some form of treatment since the cardiovascular illness that kills many with prostate cancer before the cancer is going to be much of an issue, is NOT a worry for these persons, necessarily.
Secondly (and, yes, the scientist in me balks at what I am about to say), my anecdotal experience tells me our interventions produce largely good results and very few (I cannot personally recall one) adverse effects. I think this is, in large part, due to whom we use for our surgical consultations (John Scott and David Hollensbe). These guys are really good, in fact, they TAUGHT many of the urologists around the country how to do the DaVinci robotic nerve - sparing prostatectomies.
So, I don't think all our patients are necessarily typical and I think our surgical colleagues are alot better than alot of their peers.
I do tend to share the view that screening for PSA annually is probably unnecessary. Trials assessing annual screening showed NO evidence of benefit. The ACP recommends every 4 years...I kinda think a bit more often, but, agree, not annually unless a postive family history or some other extenuating circumstance exists.
So, that's my story and I'm sticking to it...for now. If I change my mind, you'll be the second to know...