Prostate cancer screening requires patient input

Prostate cancer screening requires patient inputPredictably, reactions to the USPSTF’s prostate cancer screening guidelines are all over the map.

Consider editorials from two national newspapers, the New York Times and USA Today.

USA Today wants readers to ignore the recommendations: “Here’s our suggestion for the 50-plus male: Get tested, then get smart. Information about prostate cancer and its treatment is readily available from the National Cancer Institute, major cancer centers and other sources.”

On the other end, consider what the New York Times writes in their contrasting editorial: “Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients … The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.”

It’s unlikely that there ever will be consensus on the issue. When it comes to cancer, patients generally want to know. Dartmouth physician Gilbert Welch writes that for every prostate cancer screening “winner,” there are about 30 to 100 “losers,” meaning those who suffered complications from obtaining a PSA test.

But the story of that one winner will resonate far more than the scores who were harmed by the test.

And it will be difficult to undo decades of prostate cancer screening practice. Cancer is emotionally and politically charged. The new USPSTF guidelines are useful in bringing false positives and the fallacies of early cancer screening into the national conversation, but that’s about it.

So, what am I going to do? I’m going to discuss the new guidelines, and give my recommendation, which will be consistent with that of the USPSTF. But the ultimate decision is the patient’s, and I will respect their choice, whether they want to be screened for prostate cancer, or not.

Because, as Dr. Welch notes, “there are no right answers, just trade-offs.”

And every patient will have a different idea of which trade-offs they’re willing to accept.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • Anonymous

    USA Today: “Get tested, then get smart.”

    100% wrong. Get smart, then maybe get tested.

  • http://www.facebook.com/people/Pedro-Nunez-Jr/1240575946 Pedro Nunez Jr

    I wonder if a doctor can be sued for not ordering a PSA test and missing a prostate cancer, based on discussing the pros and cons of the test with the patient, and the patient therefore declining the test?

    http://depts.washington.edu/gim/calendar/hmcjc_abstracts/JCJul04Article1.pdf

  • Michael Blackmore

    I heartily agree with Dr Pho’s policy.  II have done this myself in over 30 years of practice. What to do about PSA testing is, in my opinion, one of the most difficult questions faced in primary (and maybe specialist) care.

  • Michael Blackmore

    I heartily agree with Dr Pho’s policy on this.  In my opinion questions about PSA testing are the most difficult that have to faced in primary (and maybe specialist) care.  I have followed a similar policy to Dr Pho in over 30 years of practice in UK NHS.

  • Gil Holmes

    Yes, famously so. There was an article in JAMA several years ago about a resident who did this and was sued. It did not matter what the science said. It did not matter what professional organizations recommended. It mattered what local ‘standard of care’ was. So being the most educated doctor who discusses pros and cons with the patient is actually malpractice.

  • Joe Kosterich

    Good piece Kevin. Patients can make a decision when they have the facts not just media hype about a “simple” blood test

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