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New Research Findings
USPSTF PSA Screening

Advanced Disease
Localized Disease
Metastatic Disease

Behind the Headlines-02

(Published October 9, 2013, The Siuslaw News)

According to Wikipedia, last month we observed the 20th anniversary of National Prostate Cancer Awareness Month. President H. W. Bush so designated it in 1993 in an effort to make men aware of prostate cancer and encourage them to get screened.
Twenty years ago, PSA testing was just starting to show the difference it could make in detecting early prostate cancer and had the support of nearly everyone. Its ability to detect prostate problems years before anything would show up with the digital rectal exam (DRE) or because of symptoms suddenly gave men hope of early prostate cancer detection and a chance at being cured. It developed a unified base of support for men to start routine screening at age 50.
One reason for that enthusiasm is explained by Patrick Walsh of Johns Hopkins: "In 1990, before PSA testing, only 68 percent of newly diagnosed men had localized cancer and 21 percent were metastatic." Why? Simply because a man's biopsy and diagnosis resulted from either an abnormal DRE or symptoms, both of which were often too late for a cure. Looking at those numbers today, he continues, "Today, 91 percent are diagnosed with localized disease and only 4 percent have metastases."
Those numbers represent thousands of lives saved and should be cause for celebrating. Instead, recommendations coming from our own medical groups now discourage routine PSA screening, particularly in young men ages 40-55. According to them, it is better not to be screened because if diagnosed, men may opt to be treated and that could lead to side effects of incontinence and/or impotence. Since they see over-treatment as the problem, they simply eliminate screening instead of working to eliminate the over-treatment. That's ok - "they" don't pay the price - innocent men and their families do.
In 2009, the American Urological Association (AUA) bravely decided that waiting until age 50 was missing too many men and recommended a baseline PSA test at age 40 along with a comprehensive risk assessment. The earlier baseline PSA and risk assessment would assist urologists in identifying young men who needed immediate attention, those whose risk factors demanded frequent PSA tests and those they could see less frequently. This got away from routine testing of all men and based future screening on each man's personal need.
Then in 2012, the U.S. Preventive Services Task Force (USPSTF) concluded that men should not be screened for prostate cancer at any age - period! The task force determined the substantial harms of treatment, incontinence and/or impotence, far outweighed the limited benefits of lives saved from early detection. The recommendation of the USPSTF was quickly adopted by the American Academy of Family Physicians (AAFP). Next, the American College of Physicians (ACP) - Internal Medicine, recommended against screening average-risk men younger than 50. This was quite similar to that of the American Cancer Society (ACS).
In 2013, the AUA, in a dramatic betrayal of young men, says: "Routine screening in men between ages 40 to 54 years at average risk is not recommended." Claiming its recommendation is now "evidence-based," instead of "consensus opinion," the AUA found a face-saving excuse to drop ages 40-54 from screening - they simply had never been included in prospective, randomized trials - hence, no "evidence." This was done with nary a mention of the 2009 AUA advocated baseline test which individualized prostate health care. From a patient's perspective, the baseline screening was the perfect answer - catch prostate cancer I might already have and schedule my future PSA tests/screening on MY risks, not a statistical factor. The AUA had it right...too bad it didn't have the guts to stick by it like Us TOO Florence.
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