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Tuesday, Apr 25, 2017
Editorials

Editorial: Bad prostate cancer advice

Three years ago a federal committee recommended against widespread screening for prostate cancer.

Many urologists warned at the time that the horrible advice by the U.S. Preventive Services Task Force, a panel that advises the federal government, likely would result in unnecessary deaths. Recent studies confirm that the testing and diagnosis of prostate cancer have dropped dramatically — almost surely the result of the task force’s flawed recommendation.

As The New York Times reports, the number of early-stage diagnoses of prostate cancer per 10,000 men age 50 and older dropped from 540.8 in 2008 to 416.2 in 2012.

Researchers don’t believe the drop was a result of there being fewer cases of the cancer, but rather the result of reduced screening.

The newspaper reports, “the percentage of men 50 and older who reported PSA screening in the previous 12 months dropped to 30.8 percent in 2013 from 37.8 percent in 2010.”

All this means more cases of prostate cancer are going undetected.

Supporters of the task force’s advice would say this is no big deal because prostate cancer is often slow growing and may never become life-threatening.

But the group, which was chaired by a pediatrician and did not include urologists or cancer specialists, ignored the fact that there also are virulent cases of prostate cancers that will be deadly if not detected early.

Without the painless PSA blood test, it is unlikely these cancers will be found until they have metastasized.

Yet the recommendation clearly has led to less concern about detection, and now Medicare officials are considering a measure that would penalize physicians who order the routine prostate-cancer screening for their patients, which would be an outrage.

The idea that the PSA test is unnecessary is, on its face, preposterous, considering how effective it had been in reducing the prostate cancer death rate.

The U.S. prostate death rate dropped 44 percent after the PSA was widely adopted in 1992.

In 1992, the age-adjusted prostate cancer rate was 39.2 per 100,000 American men. By 2007, that had dropped to 23.5 per 100,000. That was no coincidence.

And consider an even more significant number. During that time there was an 80 percent reduction in the number of prostate cancers that had metastasized at the time of the original diagnosis.

So the claim that PSA testing doesn’t save lives is utterly ridiculous.

Dr. William Catalona, director of the Clinical Prostate Cancer Program at Northwestern University’s Feinberg School of Medicine in Chicago, predicted when the task force made its recommendation it could cause the prostate death rate to double by 2025. These new research numbers suggests more people, including those with the aggressive form of cancer, are forgoing screening and losing the opportunity for a cure.

The primary concern of the task force and Medicare officials seems to be preventing “overtreatment” and is surely motivated by an underlying effort to contain costs. The priority should be saving lives.

It might have made sense if the task force had, instead of recommending against PSA testing, simply emphasized a more conservative approach to treatment.

It’s true — most prostate cancers are slow growing and may never become deadly. But once patients learn they have it, they often understandably choose costly treatments — usually surgery or radiation — that can have unpleasant side effects, including incontinence and impotence.

Now more physicians are inclined to advise “watching, waiting” — monitoring the disease’s progress before recommending treatment.

With periodic PSA testing, physicians can chart the disease’s progress and in most cases take action when necessary.

It’s likely that tests will be developed that can distinguish between a slow-growing prostate cancer and a more dangerous one. But until that time comes, regardless of the task force’s flawed advice, PSA should be front and center in the war on prostate cancer.

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