Friend or Foe? PSA Screening for Prostate Cancer Part 4

Some controversies never die.  At least for now, the debate continues over whether or not to screen for prostate cancer with prostate specific antigen (PSA) testing after the United States Preventive Services Tast Force's (USPSTF) recent draft D recommendation against doing so in asymptomatic men.  The one nice thing that I've noticed is that the comments tossed back & forth are far less inflammatory than say those barbs being tossed back & forth regarding human papilloma virus (HPV) vaccinations.

Case in point are a number of editorials published yesterday in the New England Journal of Medicine.  I would suggest starting off with "Screening for Prostate Cancer" which is one in a series of clinical case studies for which is given the standard basic information for that particular topic.  Co-authored by a family physician, vignette reviews some of the larger studies upon which the USPSTF draft recommendations were based, including a breakdown & analysis of the European data supporting screening.  More importantly, this article also discusses number needed to treat (derived from absolute risk reduction as opposed to relative risk reduction) and costs involved from a public health perspective.

In "Stratifying Risk" the author, involved in the European studies, attempts to point out the weaknesses in the USPSTF arguments.  In "One Man At A Time" and in "Prostate-Cancer Screening", while the authors agree in general with the USPSTF draft recommendations, they also cite weaknesses in application especially when it comes to day-to-day care in the trenches.

Given all the high level debate going on between supposedly well-educated individuals reviewing the exact same data (can you picture the blind men and the elephant?), how are we supposed to convey these nuances in the 15 minutes we're allotted each patient (and most patients & physicians will tell you that 15 minutes is really a pipe dream and a rare luxury).  I wish I had the solution!  Or at least good strong evidence about which everyone agreed.  Until then, let's continue to share differing ideas & viewpoints in a polite manner.

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