Friday, January 8, 2016

More on the Debate

In a Science Daily piece the authors state regarding PSA testing:

The researchers measured whether four areas were communicated with patients. Below are the areas and results.
• 17 percent of patients were told that some experts disagree about whether men should have PSA tests;
• 23 percent were told that some types of prostate cancer are slow-growing and need no treatment;
• 25 percent were told that the PSA test isn't always accurate in diagnosing prostate cancer; and
• 31 percent of patients were told that treating any type of prostate cancer can lead to serious side effects such as urinary incontinence and erectile dysfunction.

Now let us examine the 4 points above.

1. Yes "experts" disagree. Frankly it is the very definition of an "expert". I see this all the time. One need look no further than Expert Witnesses. They range from real experts who do the work they are opinion on as a day job to the full time "expert" who just make a living by opining without ever doing.

2. Yes some is slow growing and others fast. The problem is that we cannot identify which is which. And fast is fast! So do you want to take the chance?

3. PSA is not at all accurate. It is suggestive at best. But it provides a relatively inexpensive way to watch. It is not the one PSA test, it is a pattern. And as we have shown even the pattern, say PSA velocity, may not be the sine qua non.

4. Side effects, what about death?

So the debate continues. In my experience getting advice from your GP or Internist is of little value. Not because of any lack of competence but due to the complexity of the issue.