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Behind the Headlines-19

Us TOO FLORENCE - BEHIND THE HEADLINES
BY BOB HORNEY - PROSTATE CANCER SURVIVOR - Us TOO CHAPTER LEADER
(Published May 13, 2015, The Siuslaw News)

If you have followed previous Behind the headlines, you know that Us TOO Florence is consistently on the opposite side of the prostate screening controversy from the U.S. Preventive Services Task Force (USPSTF), the American Academy of Family Physicians (AAFP), the American Cancer Society (ACS) and, as of May 2013, even the American Urological Association (AUA). One must wonder why we are so contrary. Good question.
Let's approach it from this angle. Suppose you have a serious medical concern (breast, heart, liver, kidney or even prostate - you name it) being treated by a specialist whom you, from personal experience and observation with other patients, totally trust. This doctor specializes in your medical problem, keeping up on its very latest news and treatments. He/She even attends monthly support group meetings regarding your problem and you can ask any question about your ongoing recovery and life after your treatment on a month to month basis.
Now, the media screams headlines and publishes "expert" reports and recommendations from groups touting findings contrary to what your specialist has been advising at your group meetings. Plus, their findings are based on a study that many, including your specialist, consider totally flawed and never having a chance of showing valid results. Not only that, the study started over 20 years ago and the group coming up with the recommendations had no members in your specialist's medical field. Who are you going to believe? Are you going to maintain your trust in your respected and up-to-date specialist or abandon him/her for the latest headlines?
That pretty well sums up why Us TOO Florence remains firm in its recommendation that men have a baseline PSA test at age 40. How did we originally come up with that recommendation? Long story short, we got it from the AUA. It was the AUA's recommendation for 4 years, from April 2009 until May 2013, that men get a baseline PSA at age 40. It was very adamant that a baseline PSA and digital rectal exam (DRE) at that age could predict the future risk of prostate cancer 20 to 30 years hence. It even took the USPSTF to task for its flawed recommendation in 2012 that healthy men avoid taking the PSA test. Then, in an unfathomable reversal in May 2013, the AUA decided to rely solely on the results of prospective, randomized, controlled trials. Well, when the AUA went that route, it threw men from age 40 - 54 "under the bus" simply because they have never been part of those trials. After all, prostate cancer was an old man's disease so why include these young men in any clinical trial? Most of the clinical trials included men starting at age 60. The AUA now only recommends PSA screening for men starting at age 55 and ending at age 69.
Even LUGPA (Large Urology Group Practice Association) on which Dr. Bryan Mehlhaff serves as a board member, broke with the AUA, coming out with revised guidelines in September 2013. LUGPA recommends a baseline PSA test for men while in their 40s and recommends continuing offering testing for all men who have a life expectancy of 10 or more years. At least LUGPA understands that many (if not most) men at age 69 have a lot of life left in them.
Rather than follow the AUA and abandon our young men, several of whom were diagnosed in their 40s, we are sticking with our above recommendation. Us TOO Florence suggests men make it a 40th birthday present to their family instead of procrastinating for 10 years (yes, we men will do that).
Whether considering a baseline test at age 40 or during one's 40s, the importance of this early PSA baseline test cannot be over emphasized.

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