A pro/con debate over the PSA prostate cancer screening test at the ACP Observer:
Will more aggressive screening at an earlier age lead to detecting more tumors at an earlier, more treatable stage? Or would it simply lead to overdiagnosis of tumors that may never become life-threatening?
No surprise, but those in favor of a lower PSA threshold are urologists, while an internist speaks against it.
Of course, urologists wouldn’t financially benefit from the additional procedures resulting from a lower PSA threshold, would they? I’m sure that didn’t factor into their thinking.
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{ 6 comments }
Lower PSA value thresholds are meant for younger patients who will die of prostate cancer if left undetected. What is really needed beginning at age 40-50 is agood informed consent discussion between the urologist and the patient, giving data (Catalona’s) regarding lower PSA thresholds. is that what you tell your patients Kevin.
Did I hurt your feelings Kevin?
Not at all! However, the comment did not add to the discussion of the blog entry.
Thanks,
Kevin
“Of course, urologists wouldn’t financially benefit from the additional procedures resulting from a lower PSA threshold, would they?”
Come on, as urologists our waiting rooms are loaded with patients already. My schedule is booked over 8 weeks out. This is not about financial incentive; it is about finding the more aggressive cancers in younger men at a more treatable stage. Although I will probably get blasted for this, I routinely tell patients over the age of 75 to stop checking their PSA. The AUA needs to alter their PSA screening guidelines and needs to come to a consensus at what age to stop screening PSA. Maybe aggressively screening 40-60 year old men by lowering PSA thresholds will then allow us to stop PSA screening in men over 70 years of age? The problem is that this type of data needs years to mature.
So, if the threshold is lowered, how much overdiagnosis there will be? Any estimates?
“overdiagnosis”
That is a hard term to pin down. Tomorrow, I am operating on a 59yo with 5% of 1/12cores positive for Gleason 3+3 PSA 5. Would you call this insig cancer preoperatively? I’ll let you know what the final path shows. Bottomline, prostate cancer death rates have fallen for the first time so we must be doing something right.
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