At least one intelligent response to the USPSTF recommendation ...

Dan Zenka, a prostate cancer patient and a Senior VP with the Prostate Cancer Foundation, appears to have published one of the more intelligent responses to the USPSTF recommendation on PSA screening since Monday?s announcement. Have a look at his blog post.

We live in a delusional world, and cognitive dissonance is alive and well when it comes to things like the value of diagnosing disorders like prostate cancer (and breast cancer) early enough to cure them (if they need to be cured).

This morning there is an OpEd in The Philadelphia Inquirer from Dr. Virginia Moyer, the chairwoman of the USPSTF (under the heading ?Prostate cancer test does more harm than good?). Dr. Moyer reiterates the USPSTF?s position on the lack of value of PSA screening for the majority of American males. Interestingly, and simultaneously, Dr. Michael LeFevre (the vice-chairman of the USPSTF panel) is quoted as follows in a HealthDay article that appears on the Philly.com web site:

Some may say that by rating the test a ?D? we?re taking away the possibility of an informed decision, but we don?t want that to be the case, ? This decision does not preclude a man choosing to be screened.

Are you confused yet!

The dual, fundamental problem about the early diagnosis of prostate cancer that no one is really addressing is that:

• The potential benefits of early detection (curative treatment that extends life) only really accrue to a relatively small subset of the male population who need early diagnosis, whereas
• The potential harms of excessive biopsies and over-treatment (with no extension of life) are currently accruing to a much larger group of men who will never know whether they really needed treatment or not.

In addition, there is a third group of men that we can now diagnose (apparently) early and treat (apparently appropriately) with curative intent, but whose cancer ? at the time of diagnosis ? has, in fact, already progressed to an incurable stage, so these men have recurrent disease that continues to progress from micrometastatic to metastatic to prostate cancer-specific mortality over the next 5 to 20 years.

The debate about the value of the PSA test largely ignores these realities. Addressing these realities requires much better and much more specific tests that can differentiate between the 20+ types of prostate cancer that we are now able to identify, along with the knowledge about which of these 20+ types of prostate cancer are the ones that really need aggressive and early treatment when identified in specific individuals.

The other equally critical issue is a much more public acceptance by newly diagnosed patients ? and by the leadership of the prostate cancer treatment community ? that active monitoring (i.e., ?active surveillance?; and not ?watchful waiting?, which is a very different animal) is an entirely appropriate form of management for a very high proportion of men currently being diagnosed with low- and very low-risk prostate cancer (specifically including those with a life expectancy of 15 years or less).

Of course your Sitemaster is living in intellectual dreamland ? a place where logical behavior is the norm and cognitive dissonance bears a strong resemblance to an unidentified flying object.

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Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk Tagged: | PSA, risk, screening, test, USPSTF

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