A major shift in prostate cancer screening guidelines protect men from unnecessary anxiety and physical pain

Back on track

Apparently, unlimited money can’t buy the best medical advice.

Just ask billionaire Warren Buffett.

He must have the best doctors in the world. Right? And yet, the details of his prostate cancer case appear to represent seriously outmoded and misguided medical advice.

Start with PSA screening.

Actually, men, please DON’T start with PSA. You might end up like poor Buffett.

Because PSA is where this story takes a bad turn.

Looking for lifesavers

Four years ago, when Buffett was 77, the US Preventive Services Task Force issued a recommendation for older men. The task force panel said men over the age of 75 should not receive PSA screening.

Earlier this month, the USPSTF updated that recommendation.

The new guideline: No PSA for any man of any age.

You have to wonder if Buffett called his doctors the morning this recommendation was announced and asked, “What the…!?”

His doctors couldn’t claim, “This is news to us.” It certainly is NOT news. I first told you about serious PSA reservations nearly a decade ago.

And if I knew, they knew.

The task force offered three stark details in support of the panel’s recommendation…

  • About one man in 1,000, diagnosed by PSA, will avoid prostate cancer death
  • Unnecessary follow up tests and treatments harm many men
  • Some follow up tests and treatments can cause fatalities

In short, the benefit/risk ratio balances to the risk side. It’s simply unacceptable. But no matter how convincing the numbers may be, some will continue to cling to the test.

The American Urological Association recommends PSA screening, beginning at age 40. The American Cancer Society suggests age 50, and a few years earlier for men at high risk. Those recommendations aren’t likely to change until the screening itself changes.

Fortunately, change is in the works.

One new test, known as Pro-PSA, measures three different levels of PSA. The FDA has not yet approved this test.

Another test, called PCA3, detects a gene that’s commonly present in prostate cancer patients.

The FDA has approved PCA3, and early trials are promising. But we have to take a lesson from PSA screening. For years, PSA was the accepted standard. Now it’s about to be scrapped. We can’t head down a new road at full speed.

“Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement” Annals of Internal Medicine, Published online ahead of print 5/21/12, annals.org

“Task force discourages use of prostate cancer screening test” Angela Townsend, Cleveland Plain Dealer, 5/21/12, cleveland.com

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