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U.S. Preventive Services Task Force Revisits Prostate Cancer Screening

• Prostate Cancer Screening not useful ??
• Perfect Test for Prostate Cancer vs Nothing
• PSA screeening
• evidence based medicine
• Psa Screening
• PSA TESTING
• PSA Screening
• PSA Screening

Prostate Cancer Screening not useful ??

Jose GROS-AYMERICH, Asistencia Médica Valdebernardo. E-28032 Madrid, Spain, 28 Oct 2011 1:09 PM EST

Competing interests: None declared

Specialty: Oncology

How many men would like never having a test that reassures them ?. H Lilja et al, from NY, published in 2011 ASCO Annual Meeting, Abstract 4512, a proposal for a new PSA screening strategy. Men would have an initial PSA test around 45 years of age, if PSA value is below a threshold ( Don't remember well, maybe 0.4 , those with higher values send to closer follow-up), just two more testing at 55 and 60 ( Figures to be checked ) will be enough for more than 40% of men. This can reduce costs and test related anxiety and additional testing. The issue on PSA screening may be that Prostate Cancer Specific Mortality started to decrease in coincidence with the introduction of PSA test. Or not ?

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Perfect Test for Prostate Cancer vs Nothing

Hal Lederman, Jewish Guild for the Blind, 28 Oct 2011 3:47 PM EST

Competing interests: None declared

Specialty: Unspecified

So the PSA test is not perfect. By the way, what else is there?? Are men supposed to wait until the cancer shows up by digital exam, just like in the good old days, when it may be too late? Mammograms have a lot of pitfalls too. Why do we men feel that going through life with our fingers crossed, and hoping for the best, is smart?

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PSA screeening

William O. Ameen, MD, walk-in clinic, North Carolina, 28 Oct 2011 9:27 PM EST

Competing interests: None declared

Specialty: Family Medicine

Ask any of my patients, including an asymptomatic 37 yo and a 64 yo classmate of mine, among the several positive asymptomatic prostate cancer patients I find per year, whether it was worth it to be screened.

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evidence based medicine

matthew m. kreps, 1 Nov 2011 9:45 PM EST

Competing interests: None declared

Specialty: Internal Medicine

the proposal for PSA screening mentioned by Gros-Aymerich sounds somewhat promising. regardless, the comments made by Lederman and Ameen seem to miss the point however. "men going through life with our fingers cross" and individual examples of people who have been helped don't take into account evidence based medicine. the entire point is that while some people can be helped by this kind of testing, there are about the same number that are harmed by the treatment for their elevated PSA. 1) we could do an LP on every single person who comes into the hospital with AMS in the hopes of eradicating meningitis. 2) we could do a CT angiogram of the chest for everyone with shortness of breath to detect every PE. 3) we could do a cath on everyone who has chest pain. why don't we? because the number who benefit is equal to if not exceeded by those that are harmed. primum non nocere. this is why we take specific subgroups for whom a benefit is clearly demonstrated. this is why there is such a thing as the well's criteria for PE and the TIMI score for chest pain. the PSA would still have a role in following a known prostate cancer, but not for screening.

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Psa Screening

Neil K. Hall, 2 Nov 2011 10:57 AM EST

Competing interests: None declared

Specialty: Geriatric Medicine

It is amazing how many physicians can't or won't see the truth staring them in the face when in conflicts with their beliefs. Finally the USPSTF has returned to their long-ago position that PSA screenings actually are harmful overall. There never was good evidence that they improved overall outcomes for men. The fact that so many doctors don't support the very real evidence and protect our patients from the harms of this test is a sad comment about American Medicine.

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PSA TESTING

JL Brown, 21 Jan 2012 8:15 PM EST

Competing interests: None declared

Specialty: General Practice

There is a significant industry built up around prostate screening. Apparently, few men are benefiting from the test. More importantly, the test offers peace of mind to physicians and patients alike when it is negative. In my opinion, we need better screening options, and these are apparently not on the near horizon.

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PSA Screening

Bernard A. Yablin, Ret asst clin prof, 25 Apr 2012 10:08 AM EST

Competing interests: None declared

Specialty: Pediatrics

Why stop at age 75, considering the number of advanced cases that may show up after then?

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PSA Screening

Robert C. Barker, 25 Apr 2012 9:14 PM EST

Competing interests: None declared

Specialty: Gastroenterology

Does anyone still do rectal exams? Perhaps a carefully done rectal exam might be helpful in identifying those who might benefit from further testing and treatment. Perhaps some study might be carried out comparing outcomes of those screened by rectal exams and those by PSA.

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