USPSTF Is At It Again

Today, as expected, the U.S. Preventive Services Task Force (USPSTF) released its report on the efficacy of PSA screening for prostate cancer with little change over the draft version released last fall. The USPSTF recommends against routine PSA screening of asymptomatic men no longer be screened for prostate cancer. The committee, that includes no one who deals with prostate cancer patients on a daily basis and is headed by a female pediatrician, cited statistics that more men die within a month of prostate cancer surgery than would have died from the disease. Given that 28,000 American men are expected to die from prostate cancer this year, it is hard to believe that a larger number would die within a month of prostate cancer surgery. Of course, surgery is only one of a number of treatments available for prostate cancer but the others are less likely to kill someone in the short run. I suspect that the comparison would be much different if the(infinitely small) death rates from other treatments were considered. The study also cited side effects, erectile dysfunction and incontinence, from prostate cancer surgery as a reason to avoid PSA screening. Again, some alternative treatments come with lower rates of these nasty side effects. I chose proton therapy for myself because it gave me the best chance of coming out of treatment whole.

The study ignores the benefits of building a history of PSAs for each patient. For example, researchers have found that rapidly increasing PSAs, more than 0.2 increase for two successive years, not only indicates a greater likelihood of having prostate cancer but a greater likelihood of having an aggressive type that needs to be treated soon. With no history of PSAs, many cancers that need to be treated promptly won’t.

African-American males, Vietnam veterans, and men whose relatives have had prostate cancer are all at higher risk of developing the disease. Not screening these groups (two of which apply to me) will surely increase the death rate from prostate cancer. The American Cancer Society’s annual report for 2012 shows that the death rate due to prostate cancer began declining when PSA screening started and continues to fall. This fact argues strongly against the USPSTF’s position that PSA screening doesn’t save lives.

Waiting until a men presents with symptoms of prostate cancer greatly increases the likelihood that he will die or suffer nasty side effects because the disease is generally greatly advanced before the patient becomes symptomatic. Something not discussed in the report is the high level of pain those who die of prostate cancer experience. For all its numerous faults, PSA testing is still the best available option. Fortunately, researchers are working to find better indicators.

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