Comments on: New Prostate Cancer Screening Guidelines: Let the Patient Decide http://www.physiciansnews.com/2010/03/04/new-prostate-cancer-screening-guidelines-let-the-patient-decide/ Wed, 08 Feb 2012 12:53:38 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Paul http://www.physiciansnews.com/2010/03/04/new-prostate-cancer-screening-guidelines-let-the-patient-decide/ Wed, 08 Feb 2012 12:53:38 +0000 hourly 1 http://wordpress.org/?v=3.2.1 Comments on: New Prostate Cancer Screening Guidelines: Let the Patient Decide http://www.physiciansnews.com/2010/03/04/new-prostate-cancer-screening-guidelines-let-the-patient-decide/ Wed, 08 Feb 2012 12:53:38 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Paul http://www.physiciansnews.com/2010/03/04/new-prostate-cancer-screening-guidelines-let-the-patient-decide/comment-page-1/#comment-1297 Paul Sat, 06 Mar 2010 05:06:22 +0000 http://www.physiciansnews.com/?p=3057#comment-1297 First off, prostate cancer is a terrible disease and I commend urologists in their fight and plight against this scourge. That said, the PSA test is not a specific test, it is not a sensitive test. Screening tests are generally given to populations that are mainly without disease, so when there is an error it often falls in the majority group, ie the people without disease, i.e. a false positive result. If there is a positive finding the follow-up test, prostate biopsy is both expensive and poses a not insignificant risk to the patient. If the result was not a false positive their is then no good way to stratify which are the very slow growing prostate cancers which might be addressed with "watchful waiting" versus the more malignant and aggressive types. Finally if one chooses to intervene there is no home run treatment in fact its hard to say whether the treatments are often really of much benefit at all in terms of over all mortality while they carry a significant risk of long term complications. Evidently, two recent studies have now also supported that PSA screening is not of benefit and may actually be harming patients from the unnecessary procedures secondary to false positives. So likely the PSA test isn't worth it, which then brings up a related question which may sound flippant but I think is entirely reasonable. Unless you have Dr. Goldfinger, the dreaded finger wave is a worse test than even PSA as a screening test. Is their any rationale reason for a digital rectal exam as a routine urologic screening? First off, prostate cancer is a terrible disease and I commend urologists in their fight and plight against this scourge. That said, the PSA test is not a specific test, it is not a sensitive test. Screening tests are generally given to populations that are mainly without disease, so when there is an error it often falls in the majority group, ie the people without disease, i.e. a false positive result. If there is a positive finding the follow-up test, prostate biopsy is both expensive and poses a not insignificant risk to the patient. If the result was not a false positive their is then no good way to stratify which are the very slow growing prostate cancers which might be addressed with “watchful waiting” versus the more malignant and aggressive types. Finally if one chooses to intervene there is no home run treatment in fact its hard to say whether the treatments are often really of much benefit at all in terms of over all mortality while they carry a significant risk of long term complications. Evidently, two recent studies have now also supported that PSA screening is not of benefit and may actually be harming patients from the unnecessary procedures secondary to false positives.

So likely the PSA test isn’t worth it, which then brings up a related question which may sound flippant but I think is entirely reasonable. Unless you have Dr. Goldfinger, the dreaded finger wave is a worse test than even PSA as a screening test. Is their any rationale reason for a digital rectal exam as a routine urologic screening?

]]>