An update on “screening” for prostate cancer: four perspectives


To quote the abstract of the paper discussed below, the use of the PSA test to screen for risk of prostate cancer “in men at normal risk of prostate cancer is one of the most contested issues in cancer screening.” No! Really?

A new article by Armstrong et al. in the journal Public Health Research and Practice provides four slightly different perspectives on the pros and cons of population-based screening for risk of prostate cancer among men at “normal” risk for this disease (i.e., men who have no particular reason to think that they might be at higher than average risk because of race, ethnicity, genetics, or family history).

The full text of this article is available on line, and we suggest that readers look at this for themselves rather than take the sitemaster’s word for the content. It is not a long paper. The four slightly differing perspectives are offered by: an Australian epidemiologist, a US-based primary care physician, two Australian urologists, and an Australian medical oncologist.

However, what we do find interesting is that the general views of each of the contributors seem to be closely congruent with the most recent draft guideline on prostate cancer screening issued by the USPSTF … that in the end the only person who can make a decision about whether or not he wants to be tested for his individual risk of prostate cancer is the individual patient — so long as he has been well informed about the relative risks and benefits of such testing.

3 Responses

  1. what we do find interesting is that the general views of each of the contributors seem to be closely congruent with the most recent draft guideline on prostate cancer screening issued by the USPSTF

    You talk rubbish as usual. Ian Haines said this:

    This is poor public health policy. The USPSTF should not reverse its previous advice.

  2. Dear Mr. O’Neill:

    You have taken Dr. Haines’ statement out of context. His statement refers to what he describes in his prior paragraph, where he writes that:

    … some urology groups suggest that all men over 40 should consider a screening PSA test, even when we know that 24.4% of men with a ‘normal’ PSA are diagnosed with prostate cancer when they have a biopsy and it is a common finding in this age group at autopsy. Many are advised to consider radical treatment, with all the possible adverse consequences, for a disease that kills 1 in 7 (2–3% of all men) at a median age of 82.4 and for which there is still no proven survival benefit for radical intervention.

    I would entirely agree with Dr. Haines that if the USPSTF was to change its guidance to recommend screening of this type, that it would be “poor public health policy”. They haven’t changed their guideline to include any such recommendation.

  3. Thank you very much for communicating this interesting article.

    Suggestion from my side: please don’t call the men at risk patients.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: