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Richard Ablin on PSA screening for prostate cancer

Posted Mar 10 2010 12:00am

Well an OpEd in the New York Times today is going to upset a lot of men (and maybe a lot of women too) … but then as the man who initially identified prostate specific antigen, Dr. Ablin is certainly entitled to express his opinion.

To read his OpEd, you should just click here . And yes, we also have an opinion about this.

The problem with the use of the PSA test (in our opinion) is not its use. … It is its mindless use. The PSA test doesn’t give a black and white answer to anything in an undiagnosed patient, and it shouldn’t be used as if it did.

In our view most men do not need PSA tests on an annual basis to “screen” the entire population for prostate cancer. And probably tens of thousands of men who go on to get a positive biopsy test after an initial PSA test, and then go on to get treated because there are identifable cancer cells in their prostates, did not need to be treated at all. They should simply have been monitored in some way, because they very probably had clinically insignificant prostate cancer.

But the genie is out of the bottle, and we aren’t going to be able to cram it back in. We will no more be able to stop the use of the PSA test to identify men at risk for prostate cancer (even if we wanted to) than we would be able to keep bad drivers off the roads.

The two questions that we are all facing at this time are:

  • How do we use the PSA test to assess prostate cancer risk much better than we do now?
  • How fast can we find and develop a test (or a group of tests) that can actually distinguish with a high degree of accuracy between men who are at risk for clinically significant prostate cancer (and therefore might either progress to have metastatic disease or actually die of prostate cancer) and those with some cancer cells in their prostate but who have minimal risk of clinically significant disease?

The media, of course, will continue to paint all this as a “controversy,” and some people will insist on looking at this as a “black or white” issue, and will therefore forment this controversy. Those of us who tend to think with our brains as well as our emotions wish to seek a middle ground that is actually intended to ensure that we can:

  • Optimize the probability of identifying men at risk for clinically significant (potentially lethal) prostate cancer as early as possible, so that they can be treated with curative intent
  • Minimize the probability that men who really don’t need invasive treatment at all don’t suffer the harms of treatment.

This is not abortion folks! We should be able to work towards some common ground without all of the posturing and hysteria!

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