Excellent article by an excellent author…I’ve read some of his other work. He’s a Pulitzer Prize winning reporter specializing in health care. The word “screening” does not appear anywhere in this article—although he’s written about
PSA screening elsewhere as it being a cause of PC overtreatment—this article focuses on the impacts of overtreatment, and the huge (and growing) numbers of people alive today who have been overtreated.
Some good conversation in this thread. As the script
ure says, “Come now, and let us reason together.”
Inevitably, “screening” has crept into the article’s follow-up discussion. By-and-large, people
mostly now realize that the professional recommendations are
not to stop all PSA testing. Having engaged in conversations on this topic for 10-years now—and through the period of USPSTF recommendations—I am (finally) seeing a significant shift in this understanding…so huge kudos to most respondents here for “getting it” on this important point. Anyone who says something like: “the recommendation is to stop PSA testing” still doesn’t get it.
Taking this point a step further for greater clarity, rather than “stop PSA testing,” the recommendations today are for doctors not to promote PSA screening without
first having a discussion about
the test and the PC treatments—this is what’s called “educating the patient,” or at least the beginnings of the education process. Today, it is seen as unethical to perform a PSA test on an “uneducated” patient; this is what was called "routine screening" or “mass screening,” and has been dramatically reduced through medical journal editorials, books and awareness programs. Mass screening of uneducated patients=bad. Testing educated patients=can be good.
halbert, your comments—as usual—are spot-on.
BTW, my crystal ball sees today’s professional medical recommendations evolving further over time...as with just about
everything, they will continuously improve over time. I think that the USPSTF will evolve their PSA recommendations to adopt a stance which more clearly encourages PSA testing in certain situations. The data is strong for stopping testing for men without PC issues in roughly mid-70s (or men with less than 10 years LE), but African American were under-represented in the studies which found NO overall survival benefit for PSA screening, and eventually the genetic links with PC will also warrant closer monitoring. (But note that the "genetic links" are very different than just having PC in your family. As Dr Walsh said: "Prostate cancer is so ubiquitous that there will be other members of the family who will get the disease sporadically, even without genetic linkage.") That's what my crystal ball says...
Post Edited (Blackjack) : 2/5/2019 12:28:11 PM (GMT-7)