Dr Scardino of psa testing and AS

In his article, Dr. Scardino makes some potentially important points about how we should all be thinking about testing for risk of prostate cancer today, including the following:

• The benefits of regular testing are becoming more certain, but we can eliminate the risk for harm if we test most men in much smarter and much less intensive ways.
• All men would be wise to get a baseline PSA test carried out at age 40 or 45 (because that test result offers a reasonably accurate guideline as to whether a man will develop prostate cancer in his lifetime).
• We don’t need to be doing PSA tests on all men every year if they have a very low PSA level (< 1 ng/ml).
• Men with a PSA level of < 1 ng/ml can be tested every 5 years until they are in their 60s (if their PSA levels remain below 1 ng/ml).

Memorial Sloan-Kettering Cancer Center has just released its own new guidelines on screening for prostate cancer that incorporate this thinking. These are really worth reviewing. It is notable that MSKCC does not recommend PSA testing for any man of 76 years or older.

The guidelines recommended by MSKCC are very similar to the recommendations laid out by The “New” Prostate Cancer InfoLink a while ago now … and obviously carry a great deal more weight and influence. They are going to make some people very angry, but The “New” Prostate Cancer InfoLink thinks that the principles on which they are based are correct.

Importantly, in the same article, Dr Scardino is quoted as follows on the appropriate application of active surveillance as opposed to immediate intervention in newly diagnosed patients (remember that he is writing for his fellow urologists):

If you end up doing the biopsy for whatever reason (based on the PSA or DRE) think carefully before you recommend radical therapy for that treatment. Often you can put the patient on active surveillance and the risk that a cancer will grow and become serious over time is very low. We should always stop and think about active surveillance instead of active treatment. If we do those things, we will continue to save the lives of men while reducing the number of false-positive tests and reducing overtreatment.

John T,
First, thanks for guiding me to Dr Meyers video where he states that "high risk" men diagnosed with diabetes also are more likely to die of cardiovascular disease than pc..Probably have a heart attack worrying about this "crap"..
Secondly, in regards to the article and guidelines on screening I hate to see a major medical institution react to the "Recommendation"..I just read "The whole life prostate book" where targeted screening was discussed.
We all know that an annual psa test is cheap insurance, but it is what may follow that presents problems..I would appreciate your comments regarding my case below:
1..Nov 2007--psa 2.72 and dre--my Dr of many years
2..Feb 2009--psa 4.89 and no dre--new Dr..psa high & rising--monitor
3..July 2009--psa 4.70 and no dre--lower than 6 months ago--monitor--physician's assistant
4..Dec 2009--no psa or dre--urinary frequency--diagnosis--"old age"----physician's assistant
5..July 2010--emergency urinary problems--4.89psa and hard prostate..
I should note that I had complete faith and trust in my old Dr and that I mistakenly transferred this trust to my new Dr..I had no idea what psa or pc was and none of the info was presented to me until July 2010.
When I asked a "staff attorney" what the rationale was for not doing anything, I was informed that the Doctor believed in the "conservative approach"...
Under the new guidelines, I doubt that I would have been better off..Based on the new guidelines, some of us "high risk" men would be missed...Just my thoughts.
Bill--Age 70 now--a "seasoned" vet
Dx's Sept 2010--psa 4.89--5 g8's(4+4) with focal areas of 5 and 4 g7's (4+3) with epe and high volume..
79.2 g's IMRT and 3 years lupron--.06 psa after rads and <.03 now..1 year lupron to go--note: I am amazed that the lupron has kept my psa way down

Gunfighter,
The mistakes (plural) your urologist made--not following AUA Best Practices--are completely separate and disconnected with the new MSKCC screening guidelines. I hope you realize this, but you seem to be mixing the two.

Dr. Scardino makes some potentially important points about how we should all be thinking about testing for risk of prostate cancer today

it's a little late for this group don't you think ?

ed