The controversy over PSA testing is tough. Nobody wants to hear that although prostate cancer is the second leading cause of cancer death in men behind lung cancer that there is no good reason to believe that PSA testing leads to either longer or better lives. It is a tough dilemma. Death from prostate cancer is not good. Men sometimes die after long, painful illness with metastatic bone cancer and a wasting painful death. Everyone including me wants to believe that early diagnosis must be good. Unfortunately the evidence just does not lead you to that conclusion. You may have enjoyed my last post on Prostate Cancer Screening, “Don’t Do Something: Just Stand There” and in todays New York Times is a very thourough historical and analytical article outlining the controversy of PSA screening. It is full of emotional quotes by advocates and skeptics. Also is a link to Dr. Kenny Lin’s latest article on the subject also. These make a good read for anyone considering PSA screening.
Can Cancer Ever Be Ignored? by Shannon Brownlee and Jeannie Lenzer
I especially like the article’s visual. It raises the seldom stated but often considered axiom that every good primary physician knows: If you don’t want to know the answer, don’t ask the question.
Dr. Kenny Lin, a key player in the PSA debate as the ex-USPSTF point investigator on the PSA screening dilema who resigned in protest of political pressure to withhold new recommendations to make PSA screening a grade D (as in don’t do it) for PSA screening in healthy males that was based on the best available evidence but was politically unacceptable writes another excellent discussion of the topic:
The Meeting that Wasn’t Revisited by Kenny Lin MD.
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NOTE THAT SINCE THIS WAS POSTED THE USPSTF HAS POSTED A PROPOSED UPDATE TO THEIR RECOMMENDATIONS FOR PSA TESTING FOR MED AS A “D” RECOMMENDATION, i.e. RECOMMENDING AGAINST USE OF PSA AS A PROSTATE CANCER SCREENING TOOL.