Many of you follow Advisory Board Member Howard Wolinsky’s articles on his prostate cancer journey in MedPage Today.
An article Howard has been developing for some time, The Swinging Pendulum of PSA Screening, was finally published this morning. It included not just thorough research (as always!) but interviews with significant names …. and I do NOT include myself in that crew. One of those names was USPSTF Chair, Dr. Alex Krist who agreed with many of us “that (prostate cancer) overtreatment could have been prevented if doctors used the PSA information more judiciously.”
Howard’s article goes on to quote Dr. Krist ….
“Back in 2012, the data actually showed that that’s not what was being done.In fact, 90% of men with low-grade prostate cancers were getting surgery and radiation,” said Krist. “And we know today that that is overtreatment, and the treatment patterns changed between 2012 and 2018 [when USPSTF again reviewed its PSA guidelines].”
What breaks my own heart are the number of men now diagnosed so late that their disease is already metastatic resulting from not being PSA tested and its D Grade awarded by the USPSTF … and many of these men are in their 40’s and 50’s. Just last week we buried a 55 yr old man with two young kids diagnosed de novo metastatic in 2016. He had a family history … a reasonably intelligent GP should have known that and tested his PSA starting at 40 or 45. And he should have been tested for an inherited mutation and never was … but that’s a whole different blog post!
Remember, PSA TESTING IS ABOUT INFORMATION NOT TREATMENT! What you and your doctor do with that information is between you …and that is why you have to be your own best advocate. That said, without information, it’s tough to advocate!