In 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.
