In a commentary in Forbes, Dr. Marc Siegel, an associate professor of medicine at the New York University Langone Medical Center, writes that “the American Cancer Society completely missed the boat when … they suggested not screening a patient until the age of 50 and de-emphasized the use of the prostate-specific antigen test and the digital rectal exam.” Apparently even some in the primary care community are less than enthused by the new ACS guidance on screening for prostate cancer.
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Its just the same old appeal to emotion with promises that “treatment” = “cure” with no discussion whatsoever of what the scientific evidence demonstrates are the actual outcomes.
He gives an anecdotal claiming 80% restoration of sexual function, but gives no hard data to support it. He admits to unethical behavior when he says he violates virtually all the current, scientifically based guidelines and screens men prior to any discussion. He is doing a terrible disservice to his patients and the readers of Forbes. The fact that there are primary care physicians like him currently practicing is disturbing.
I wouldn’t take this guy seriously. I saw him interviewing Dr. Samadi on Fox News a few weeks ago. Or did I. As my husband put it, this was not an interview but an INFOMERCIAL.
As far as the side effects of surgery improving over time, I’d like to see the proof for that. In any case, improvement or not, the side effects are still awful.
I was looking for some information about erectile function and came across something in a textbook written by Dr. J. Mulhall, an expert in sexual medicine who treats a lot of post-RP patients. Dr. Mulhall quotes one well-known robotic surgeon who reported a potency rate of 100% in a group of his of his RP patients 48 months after surgery. So 80% isn’t so great.
Guys, you are missing the key issue: Should men get tested for prostate cancer and then have a more thorough discussion with their doctor about what to do if the test results suggest a possible problem? vs. Should doctors essentially try to talk men out of getting tested at all?
Given that 90+% of prostate cancers caught before they spread can be cured, and that essentially none after they have spread can be (and as someone well along in the latter category), I am appalled at the ACS’s recommendation. The only real gains against prostate cancer deaths over the past 30 years have come from earlier detection. ACS’s recommendation will reverse that.
P.S.: Be mildly skeptical of anyone in the medical arena who claims “100%” on anything. If it is true at all, which is an entirely other question, it may well be because of how selective they are in choosing who to treat. It is easy to be “perfect” if you only treat textbook perfect candidates.
It is disturbing that the ACS took so long to state a more balanced view WRT prostate cancer screening after years of overstating the risk to most men and understating the risks involved with treatment.
It is disturbing that Forbes would publish something so one-sided (and simplistic) that quotes doctors with extreme views.
With all due respect, Mr. Arnold, it is you who is missing the key issue.
The claim of a 90% “cure” rate with no qualification is extremely misleading, and when bandied about by health care professionals to the general public is outright deceptive. It suggests that serious health problems (including death) that would have otherwise occurred are prevented in 90% of the men who are treated. The controlled studies are showing that the real number is that only a few percent of men who are treated due to screening actually benefit (treat an additional 48 to save 1 life in the European study, for example). The large majority who receive no benefit haven’t been “cured” of anything (which is why I always put the term in quotes).
The “restoration of sexual function in over 80% of patients” “using the latest technology (robotic surgery)” is similarly misleading/deceptive, suggesting lower erectile and urinary side effects with robotic surgery. As discussed in this blog, the recent Hu et al. study (JAMA, 2009 Oct 14;302(14):1557-64) indicates that the opposite is probably true … a higher incidence of long-term effects has been observed with less-invasive surgery (including robotic). The new ACS guidelines are designed to ensure that men are aware of these facts (and many others) prior to making a decision on screening, not to try to talk men out of getting tested at all. I really don’t understand at all why these recommendations (now shared by virtually all of the major medical associations) are controversial.
One other comment of Siegel’s I find disconcerting is his statement that he “practice(s) the art of medicine”. If you want that you might as well see a witch doctor. Patients deserve nothing less than the best scientifically supported care available. His commentary demonstrates all that has been wrong with prostate cancer health management and has led to the “health disaster” mentioned by Richard Albin recently in the New York Times (discussed a few entries down in this block). The medical associations are now almost universally acknowledging this fact. Siegel should be severely reprimanded by the associations for ignoring the guidelines established based on actual scientific results and relying on anecdotes instead.
Spin and emotion; smoke and mirrors.
Of all the nonsense, this was the one i focused on:
“Whereas the ACS now suggests that I spend 20 minutes discussing the advantages of prostate screening before I do it, instead I choose to have this discussion after I check a PSA and perform a digital rectal exam.”
I think he means after I have checked PSA, performed DRE, and obtained a positive biopsy, else why object to having the 20 minute talk BEFORE a PSA test instead of AFTER. What nonsense.
And if it takes 20 minutes to discuss the pros and cons of PSA tests (as recommended by both ACS and AUA), surely it must be a very complex subject and one which every man should understand so that he can make an informed decision?
Terry:
The one thing that I am quite sure about is that this primary care physician has never done a prostate biopsy in his life.
I wonder how many of the critics of the ACS position have actually read the paper “Should I Be Tested for Prostate Cancer?” put out by the ACS.
To a simpleton like me it sets out clearly and concisely the chief pros and cons of PSA testing (as opposed to PSA screening — a different thing altogether).