PSA screening today: four points of view in the NEJM


This week’s issue issue of the New England Journal of Medicine includes four perspective articles on the recent draft recommendation about PSA screening issued by the U.S. Preventive Services Task Force (USPSTF).

The four articles are:

These four different perspectives on a relatively straightforward recommendation from the USPSTF only go to demonstrate the varying perceptions of the complexity of this issue. Interestingly, it is not the urologist in the group who is the most assertive supporter of a different draft recommendation.

You can leave comments and vote.

5 Responses

  1. The comments are quite interesting, but among the proponents for testing is the idea that each person should decide if the benefits are enough to undertake the potential for harm rather than have the task force decide. I wonder if this doesn’t create an incredible dilemma in two ways: First, practically every drug that goes through clinical testing helps some people yet the FDA time and again denies approval based on harm exceeding benefit. If we adopt the philosophy that people can decide for themselves when the best data shows that overall benefit is very small or none, then why have an organization review these studies and be charged with approval or denial? Just let everyone decide if they want to take the drugs after being informed of their odds of benefiting. Second, what about the cost? If everyone could decide that they want something even when it produces little or no benefit, the bank will be broken much sooner, leaving inadequate funds to pay for things that really are an important benefit to patients.

  2. Fritz H. Schröder’s article suggests a very thorough way to choose candidates for biopsy with a high likelihood of non-indolent disease. But I see two problems. The first is that I don’t believe that general internists are always that good at doing DREs. So as a screening input it seems a bit iffy. The second is that he seems to be advocating that men with quite low PSA levels undergo the other screening tests. But surely performing so many MRIs, etc., would be pretty expensive.

  3. Oh … You mean that there is a COST issue here too? [That's supposed to be a joke!]

  4. Yeah, of course cost is not an issue. This is a controversial issue and I have personally benefited from the system , BUT…

    Health care in America costs 17% of GDP compared to about 9% in Europe where everyone is covered. Warren Buffett said, “It’s like a tapeworm eating at our economic body”. Costs are rapidly growing with new technology and drugs, and demographics (ageing population) are working against GDP and in favour of higher health costs. Treating an indolent prostate cancer costs about $50,000, wrecks your sex life, and stops you going shopping unless there is a toilet nearby. Two doctors have been successfully sued for not testing PSA after consultation with patients as per the current guidelines. People are demanding proton beam therapy at astronomical cost, and monopolistic drug companies are charging $100,000 to pop a pill that prolongs life, for most patients, for less than 4 months. How will the grandkids feel about paying 30% or 40% of national output for health care? With that and the bizarre costs and talent drain of Wall Street and the legal system the USA is going the way of Ancient Rome, but about 20 times faster.

  5. See today’s OpEd by Zeke Emmanuel in the New York Times for additional info on cost factors and the American health care system.

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