Will patients accept the limitations of prostate cancer screening?

Recent studies in the NEJM have fueled the uncertainty surrounding prostate cancer screening.

The USPSTF recommends against screening men older than age 75 for prostate cancer, and gives an “I” recommendation for younger men.

Despite the controversy, there are plenty of anecdotes of men whose lives were saved by the PSA blood test. Will the lack of evidence sway men away from getting the test?

Judging from some of these letters in the NY Times, the jury’s still out on that.

For instance, consider this response, where a reader writes:

It may well be true that as your front-page article suggests, statistically the PSA test “saves few lives,” but on a much more personal and emotional level, one can be a very large number indeed. “Few” is in the eye of the beholder.

This precisely illustrates the problem of decisions based on evidence-based medicine. Those whose lives were saved by prostate cancer screening will have much more emotional pull than the majority for whom screening was ineffective.

I think the problem is the PSA test itself, which is wholly inadequate for prostate cancer screening. Once a more specific test is found, I suspect that much of the controversy will be alleviated.

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