New “six-point” statement about prostate cancer screening (redux)

Three weeks ago we mentioned a new six-point statement about PSA screening developed at a meeting in Melbourne, Australia. We would note that an updated set of information about this statement is now available on the BJU International web site.

The updated statement contains detail that was not available when the statement was first publicized. In particular:

  • There is a complete list of the experts who contributed to this statement … and it should be noted that they definitely all come from the “pro-screening” lobby!
  • The detailed information does address a couple of concerns, in that
    • It points out that while screening may be appropriate for some men of > 70 years of age “regular PSA screening should be discouraged” in others of 70 years and older.
    • It notes that those men who get a baseline PSA test in their 40s that shows a PSA value below the median of 0.5–0.7 ng/ml “could be spared regular PSA testing as their future risk of developing prostate cancer is comparatively low”.

The “New” Prostate Cancer InfoLink still does not believe that the new guidance is the perfect answer to the question of what patients need to know about testing/screening for risk of prostate cancer. It is an improvement, but it does not acknowledge the very real fact that

  • 5 of every 6 men will never get diagnosed with prostate cancer in their life time, but that
  • Every time those men go and get a PSA test they are at risk for being told they need a biopsy (which comes with significant risk for complications, whether the patient has prostate cancer or not).

At the end of the day, our current methods for assessing an individual’s risk for clinically significant prostate cancer are still poor … and we need to remain focused like a laser beam on being able to do much, much better in the near future.

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