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Your comments on my Monday posting about the task force’s recommendations on PSA testing are greatly appreciated.
They were lively, for the most part civilized, and illustrated the complexity of the subject. As the physician in our "Nightly News" report said, “This has been one of the most gut-wrenching aspects of medicine.”
In response to what many people said I want to repeat that these are recommendations made for the entire population based on what the panel sees as the best evidence. They are intended to serve as a starting point for a conversation between a man and his physician. They are not an absolute declaration about what any one person should do about his health care.
To answer some questions that were raised:
- Some people asked about how the guidelines apply to younger men. There were no specific recommendations for younger men. The two big studies of the efficacy of routine testing were done in men in their 50s, 60s and 70s.
- Some asked about guidelines on what to if prostate cancer is detected. The task force did not discuss that issue. The panel certainly made no recommendation against treatment. But its mandate was to assess the utility of routine screening of healthy men.
- As for the question of whether prostate cancer is potentially life threatening, despite Gleason scores and other methods for staging prostate cancer, the issue remains difficult. Much research is being directed at trying to find a molecular marker that would indicate which prostate cancer poses the greatest threat.
- Others asked why false positives are a bad thing. False positives -- or in the case of the PSA test even some not-false positives -- can lead to unnecessary treatment, which can have serious side effects.
Click here to read Robert Bazell's earlier piece about the PSA test guidelines.
Leave a Comment:
Too bad the article doesn't mention his ERA, won-lost record or strikeout ratio. If his ERA is near or over 4.00 especially against HS hitters he really isn't all that great. A 90mph fastball doesn't mean crap if your walking more then your striking out or losing more games then your winning.
With that said I do wish the kid all the best in his quest for a major league career.
OOPS: Posted to the wrong article......... sorry
From what I have read, prostate cancer takes a long time to develop so long-term studies are a must. On the other hand approaches to PSA, to biopsy analysis, and to treatment of prostate cancer have evolved and hopefully improved over the past few decades so current studies at best reflect what once was the situation but may not tell us much about the presemt. So at best the USPSTF studies may show that PSA testing averaged over all practices and all treatments 15 years ago. This may not be helpful for the present since advances have occurred based on developments in biomedical science. So each man, and each woman who loves a man, needs to ask. Who would you go to for advice about prostate cancer -- generalist statisticians with no expertise in prostate cancer analyzing rather old occurrences, or leading experts with lots of experience using the latest techniques. Sure in some cases newer doesn't mean better, and yes some MDs are just motivated by $$ and ego -- so find someone you trust, but don't in my opinion trust someone who just sees you as another statistic.
Disclaimer: PSA testing in the late 90's uncovered an otherwise symptomless agressive cancer in my prostate. Anecdotes based on small samples such as me and so many others writing in, still bouncing my grandchildren on my knee, may not be "proof" but certainly are "existence proofs" of the good PSA testing can do -- the successful end of the bell curve. My still being alive and cancer free is to statisticians a grain of sand, but to me a hugh mountain. Each of us needs to ask -- should we settle for the grain of sand in the eyes of the epidemiologists, or try for the mountain using our God given mental processes and the best MDS we can find? Massive statistical studies based an infinite range of conditions aren't proof of anything, except that there are an equal number of bad outcomes as good outcomes. What the task force should do, if it wants to be truly helpful and not just massage the egos of internists, is find out how to be on the successful end of the bell curve through appropriate use of PSA testing, MD expertise, and present day technniques. But that would take expertise in urology and prostate cancer, something noticeably absent from the task force (apparently because urologists can't be trusted -- but if I accept that premise, then certainly no MDs can be trusted.... so it's back to medicine men and women)