By Ravi Goud, MD, MPH

The prostate has been in the news lately due to the new guidelines released by the U.S. Preventive Services Task Force (USPSTF). This body of independent healthcare providers and scientists from academia and the private sector reviews and evaluates scientific data regarding screenings and interventions intended to prevent disease. Changes in recommendations can cause confusion for both patients and healthcare providers and, to avoid this, it is important to understand the nature of medical screening and interventions, the USPSTF and the specific recommendations.

To clarify the nature of medical screenings, it is best to start with the writing of Hippocrates and his oath, which encourage physicians to “do no harm.” This appeal is based on the sound recognition that most, if not all, medical interventions have both beneficial and detrimental effects. Patients, doctors and nurses have long recognized that medications have side effects, and interventions such as a surgery can cause complications. It is therefore important to evaluate potential harm and benefits to make sure that the overall effect is positive. This is what the USPSTF does for screening tests.

Medical tests are not perfect; a screening test can correctly identify disease, or it may wrongly label a healthy person as sick. In the latter case, a healthy individual is exposed to unnecessary medical and surgical interventions that are more likely to cause harm than good. We have all heard of, or met, a grateful cancer survivor who credits his or her survival to appropriate screening. Unfortunately, we do not hear of cases in which the opposite occurs.

A colleague once relayed his experience with a patient who insisted on having a prostate cancer screening even though the patient was healthy and was not a candidate for screening according to existing guidelines. Due to an indeterminate and borderline test result, further testing was required. The patient was hospitalized for surgical evaluation and he became infected with a hospital-acquired pneumonia that required treatment in the intensive care unit. The patient ended up not having prostate cancer, but almost died as a result of the evaluation process.

It is USPTF’s responsibility to review these positive and negative outcomes from carefully conducted studies, and to determine if screening a healthy individual — one without any symptoms or specific risk factors for a disease — will do more good than harm. The  USPSTF does this without considering the costs incurred or saved through screening.

In USPSTF’s latest draft statement, which is currently open for public comment, they “recommend against prostate-specific antigen  (PSA)-based screening for prostate cancer” in healthy patients of any age. The PSA test detects blood levels of the prostate-specific antigen, a protein made in the prostate, and which can be elevated as a cause of cancer or other conditions. The latest recommendation is based on findings showing that prostate cancer detected through a PSA test is very unlikely to cause death. In addition, most men that are diagnosed as having prostate cancer through a PSA test are in fact healthy, and are falsely diagnosed. Lastly, unnecessary evaluations and interventions resulting from screening can cause patient anxiety, infection, bleeding, incontinence and erectile dysfunction.

It is important to remember that this recommendation does not dissuade patients and healthcare providers against vigilance for prostate cancer. Patients, nurses and physicians should still monitor for clinical signs and symptoms of possible prostate cancer, as patients detected through this manner are more likely to benefit.

In fact, the USPSTF suggests that individual patients should make informed decisions regarding screening in consultation with their healthcare provider. For more information about the USPSTF, the prostate cancer screening recommendation and other recommendations, please refer to www.uspreventiveservicestaskforce.org.

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.