Confused about prostate cancer screening? Make a shared decision

Confused about prostate cancer screening? Make a shared decisionIn a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men.

Case closed, right?

Hardly.

The prostate cancer screening debate has been raging for the past decade. Increasing amounts of evidence show that screening does not save lives, and increase the risk of complications like impotence and urinary incontinence that stem from invasive diagnostic tests and treatments.

Regular readers of KevinMD.com are familiar with the arguments, which have been documented here extensively.

The issue has also been highlighted by Warren Buffett’s recent prostate cancer diagnosis, which gave a high-profile face to the issue.

So, where do we go from here?

Prostate cancer screening is an ideal topic to include patient input. Like prior screening controversies, like ovarian cancer screening, it is difficult for the American public to base their decisions solely on the evidence.

There’s the poor understanding of what risk actually is, and how it’s perceived:

Julie Downs, director of Carnegie Mellon University’s Center for Risk Perception and Communication, said that patients often think of cancer the same way they think of infectious disease — as a toxin in the body that needs to be expunged, rather than cells gone awry that might best be left alone. Intuitively, it’s hard to regard cancer as a condition you’re more likely to die with than to die from.

“People think, there’s this thing in there, why wouldn’t you want to get rid of it? It doesn’t make sense to say, why don’t you just leave it there,” Downs said.

What’s more, taking a test gives fearful patients a feeling of control, she added. Take away the screening tool and you “take away the one thing I felt I could have done,” she said.

The media attention that news like this brings is an ideal opportunity to further educate the public about these risks, and that not all tests are beneficial to patients.

However, there is a substantial portion of the population who understand and accept the risk of impotence or incontinence for the security of knowing what their PSA is.

They shouldn’t be ignored either.

More than ever, doctors should discuss the pros and cons of prostate cancer screening with patients. Include the new recommendations from the USPSTF. Discuss the potential complications. Even personally recommend against it.

But after answering patient questions, they should then ask, “Would you still like to be screened for prostate cancer?”

No matter what the answer is, physicians should then proceed along that shared decision path.

Confused about prostate cancer screening? Make a shared decisionKevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.facebook.com/profile.php?id=826734007 David Hanson

    Why waste money (insurance and government) money on a screening test that does more harm than good?  “Shared” decision making makes sense if the person is paying for his own PSA test instead of using insurance or government benefits.  It makes no sense to  enrich urologists by taking a test that causes harm.
     

  • southerndoc1

    The USPSTF did not recommend against prostate cancer screening, they recommended against routine screening. Big difference.

  • http://twitter.com/Hootsbudy John Ballard

    Why isn’t someone explaining the difference between screening and diagnostic testing? 
    (The difference, of course, is the presence of either symptoms or genetic history versus neither.) 

  • sFord48

    Why is it that the unnecessary screening is a shared decision while unnecessary testing is not.  If I want the security of that CT scan, why am I an unreasonable patient to be ridiculed in the medical blogoshere?

  • Jon Mikel Iñarritu

    Dr John Lynch, member of the Board of Directors of the AUA, strongly disagree with‪#USPSTF‬ statement on ‪#ProstateCancer‬http://youtu.be/XeGDJ19cRfQ 

  • rb1usma

    when I was in Med school (  ’81) you could be followed by the educated finger of the head of the Department of Urology and not be assured that your prostate cancer would be detected early or at all. It was a common clinical lecture to have a gentleman coming in for something like cough or hip pain and xrays to investigate that would turn up metastatic prostate cancer. This presentation is far less frequent and PSA have had something to do with that.. maybe death prevention  is not the correct measure of theusefulness of PSA variable.. The idea of going back to the days of to the days prior to PSA does not seem for the population.The RIsk stratefication seems to be a good middle ground.  I applaud the stategy of watchful waiting with healthy living, but you don’t have to have cancer for that to be a good option..

  • lee oberg

    I’m alive ONLY because of routine PSA at my annual physical a few years back.  Further diagnosis identified PC growing rapidly… only detection allowed early action.  Interestingly this just happened to a friend of mine… so I’m not buying this BS about no testing. PSA tests do not cause problems, and they are one of the cheapest tests around.