Prostate cancer detection and associated risk management

Dr. Michael Barry has been a long-time advocate for caution in the appropriate use of PSA testing and for awareness of the risks of over-treatment of low-risk forms of prostate cancer. He is also a current member of the U.S. Preventive Services Task Force (USPSTF), but he has advised us that he has only just been appointed to the USPSTF and claims no responsibility for the development of the most recent set of draft recommendations on prostate cancer screening.

In a recent issue of Medical Clinics of North America, Barry and Simmons have published a review article for the primary care community addressing current thinking about PSA testing in the early detection of prostate cancer; the actual benefit of PSA screening in prevention of prostate cancer-specific deaths; the role of active surveillance in decoupling prostate cancer diagnosis from immediate treatment for appropriate patients; and the importance of individual patients being informed and having the right to make their own decisions about whether they do or don’t want to have PSA tests done.

Medical Clinics of North America is a widely read and authoritative journal that regularly reviews key topics for the primary care community. The “New” Prostate Cancer InfoLink is very pleased to see an article like this by someone of the stature of Dr. Barry in this journal. It will help to give primary care physicians a fuller appreciation of the importance of shared decision-making between doctor and patients with regard to:

  • Decisions to have or not have PSA tests (based on everything from clinical signs and symptoms to race, age, and family history of prostate cancer) at particular points in time and
  • Decisions about whether immediate treatment or careful monitoring may be wiser choices for individual patients — particularly those older patients with low-risk prostate cancer who are at very, very low risk for progressive and metastatic forms of prostate cancer (let alone prostate cancer-specific mortality).

It is likely that some will quibble over details in this review. That is in the nature of the beast. However, The “New” Prostate Cancer InfoLink is of the strong opinion that we have made great progress over the past 5 years in increasing awareness of the risks as well as the benefits associated with PSA testing and the benefits (as well as the inevitable risks) of active surveillance as a first-line management techniques for the many, many men initially diagnosed with low-risk forms of prostate cancer. Dr. Barry has been a key opinion-leader in helping to build this new consensus.

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