• Prostate cancer testing and treatment [podcast]

    Last week, the US Preventative Services Task Force recommended against routine screening for prostate cancer. Like their recommendations for mammograms in 2009, this one has stirred up a bit of controversy. We discuss it in the podcast below. For more on prostate cancer screening and treatment, see the FAQ entry. For more on our podcasts, see the podcast archive.

    Programming note: Due to scheduling conflicts, there will be no podcast this Friday. We hope to post the next one on October 28.

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    • Couple of comments:
      1) I think your assertion that PSA is a very sensitive test is kind of off. I think one of the big problems with PSA is that it is NOT a sensitive test. The most recent numbers I saw were that with PSA cutoff of 4 (not sure about the units) sensitivity for cancer was ~25% and sensitivity for gleason 8 or greater cancer was only ~50%. I think this may surprise some people, as we always talk about the overdiagnosis of prostate cancer, but I think it at least partially explains why PSA testing does not confer a significant survival benefit.

      2) And this goes for the national discussion as well, but the “side-effects” of radical prostatectomy discussion should include the caveat that for many people incontinence and impotence are short-term (less than 18months) consequences of the procedure. The first info i could find on this is a study by Walsh et al from 2000 about radical prostatectomy for low-grade prostate cancer.

      3) I think there is a serious question about the psychology of the “if you have cancer, you must treat it” assumption. Why do we assume that that must be true, but that people will be comfortable with not getting tested when the data (now nationally publicized) shows that the majority of older men harbor cancer?

      4) Last thing, I think that (at least of those I’ve spoken to) Urologists are surprisingly OK with the USPSTF recommendation. I think a lot of them see it as a move from blanket uninformed testing, to serious informed discussion (probably by a Urologist) prior to testing. There is nothing harder than trying to convince an obstinate 75yo w/ COPD and multiple stents that he doesn’t need a biopsy with a PSA of 5 (or 6, or 8), especially when your main point is “you’re going to die before the cancer gets you!”. I think most Urologists will not be sad to see that part of their practice disappear…

      for full disclosure, I am a Urologist in training, and have had most of my exposure to academic center Urology (where 75yo’s w/ PSA’s of 5 don’t get biopsies….). I too struggled with peds (med-peds actually) vs. Urology, and partly decided on urology because I find prostate cancer to be interesting on so many levels (from the nitty-gritty of radical prostatectomy, to the big picture societal value of PSA testing!).