Differing perspectives on prostate cancer testing for healthy men

As fodder for the ongoing discussion about the appropriateness of PSA testing (particularly of younger, healthy men) and risk for prostate cancer, we would draw our reader’s attention to an article from the Annals of Family Medicine just reprinted on the Medscape web site.

In their article, Hoffman et al. deal very specifically with the (at least potentially) differing perspectives of primary care and specialist physicians in how they think about this complex subject, and the impact of specialist guidelines on the routine practice of being a primary care physician. (There are, in all truth, only so many hours in the day, and a primary care physician could easily spend the whole day explaining screening opportunities to people as opposed to treating their rather more serious, immediate problems.) Hoffman et al. also make the point that introducing PSA testing for all men (regardless of their actual risk for prostate cancer) at age 40 places us at risk for “expos[ing] many to the risk of harms for the benefit of very few.”

The “New” Prostate Cancer InfoLink is not going to get drawn into yet another discussion about the rights and wrongs of screening. We have all beaten this poor horse near to its death. What is important for us all to understand is that differing perspectives and opinions are at least arguable and may have considerable merit, and “one size is not going to fit all” in how we think about this issue.

2 Responses

  1. I can understand your not wanting to continue debating, but you provided the paper. I responded to a MedScape printing of this paper with the following:

    Regarding the Prostate Cancer Screening Controversy:

    A recent study attempts to resolve the PSA controversy. I agree with this part of the conclusion, with particular note that the first sentence is the real reason there has been any controversy, with the fault being those physicians -– usually urologists -– who encourage immediate biopsy/treatment:

    ‘The harm from the test is a result of overtreatment with biopsies or surgery. The best course of action would be to have a PSA test. If it is abnormal and an invasive procedure is recommended, it would be prudent to obtain a second opinion. It is important to ascertain not only the urologic surgeon’s skill but also his “surgical aggressiveness.” And any such screening should include a digital rectal examination (DRE) to determine tumor development or other abnormal gland presence. The prostate glands of many men do not produce PSA despite cancer development and the DRE is an alternate source of cancer development evidence.’

    Much more comprehensive reasoning to the importance of screening for prostate cancer is provided in two articles by medical oncologist Stephen B. Strum, having specialized specifically in research and treatment of prostate cancer since 1983: see “The PSA Controversy, Part I” and “The PSA Controversy, Part II.”

  2. May the horse rest in peace. It was a fine horse.


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