The NY Times has an article regarding the increased mortality of prostate cancer in American males. In 2012 the USPSTF stated that PSA testing should not be done in men over 70. They relied upon studies in NEJM based in Europe and the US. At the time I stated the studies were flawed. (Also see A, B, C) Finally, multiple studies supported my analysis back then,
PSA has problems but death from PCa also is a problem. In today's environment an elevated PSA would result in a multi parameter MRI. Even that has problems. For example the diffusion weighed scan can show positive result on scars from past prostate biopsies, Then the biopsies have some negative sequella such as infections but frankly at a well experienced site that is a very low risk.
The Times notes:
Many experts in the field say that reducing routine screening may have inadvertently led to a bump in severe disease. “It’s not easy to link a specific guideline to a worsening of disease, but it’s fairly convincing that the U.S. Preventive Services Task Force’s 2012 recommendations were very harmful,” said Dr. Jonathan S. Fainberg, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York who was not involved in the new report.
But, it was clear to anyone who read the studies that they were flawed. I detailed that at the time. It took almost 15 years to seek a remedy.
Men over 70 have a high risk of PCa. The rule of thumb is that men of 70 have a 70% chance, men of 80 and 80% chance and so forth. But that change may mean an indolent and limited PCa presence. Thus for most 80+ men, if they have PCa then the PSA may be slightly elevated but it is not spreading.
In my opinion and my experience the USPSTF has issued multiple flawed recommendations. Breast cancer is also on their list of flaws. The recommend no mammograms after 75 but many women over 80 have BCa! So what do we do, just abandon them as well!
Perhaps we abandon the USPSTF!
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