Saturday, June 17, 2017

PSA Testing

I bought my first copy of Scientific American in early May of 1960 on a news stand on Lexington and 52nd Street. I had just returned from my NYC Lifeguard course, and also awaited my being sent to Coney Island. But now I had this window to science. Each article was an opening to some new state of the art discussion. Written by the best of the best and in a manner which assumed you had some reasonable basis to understand. I worked really hard to meet the demands of the authors. I read and reread each article to understand it. I took what little money I had from being a Lifeguard and bought a subscription. I kept it until the magazine turned into something just worse than Time. It became, about in the year 2000, a rag, at least in my opinion. Too bad, it was a window to science, but along came the Internet so who really needed it anyhow.

So I ran across a rant by some person in Scientific American bemoaning the PSA test. He states:

I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I’m 63. I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test. When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.

Having written and done work in this area, yes go check me out if you don't believe me, I see that the PSA has substantial merit. The harms are all too often in ones head. A bit of hematuria,  some slight discomfort, but overall not that bad. My dentist is worse! Really worse.

He continues:

Just to be clear: you are 240-120 times more likely to misdiagnosed as a result of a positive PSA test and 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved.

I do not know where this came from. It seems to imply that of the 240 high PSA tests and PSA velocities done only one in 240 yields a positive PCa. Not in any tests I have seen, and no basis for the claim.

He also states:

In 2012, the U.S. Preventive Services Task Force, a federally funded panel of experts, recommended against the PSA test, saying the cons outweighed the pros. The decision was based primarily on data from two large studies, one done in the U.S., which found that screening did not reduce mortality, and the other in Europe, which showed a modest reduction.

Well first, the two trials had fatal flaws which we and others have discussed at length. Second, the USPSTF is NOT a panel of experts on PCa. They are what I would call a "fishing, drinking and smoking" club of  some physicians and others politically connected who have been allowed to opine and now control our health care! There was not a single urologist on the panel.

I would suspect that some sixty years ago Scientific American would have had some set of experts opine. Now they have some fellow with an attitude. Good luck young man!