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Some primary care physicians, however, have decided to simply stop offering PSA screening, unless a patient asks for it.
“I haven’t eliminated PSA screening from my practice, but I’m probably ordering fewer tests,” said Dr. Jonathan Berz, a primary care physician at Boston Medical Center. “There are a number of other screening tests, like colon cancer and cholesterol, that have stronger evidence behind them, so I’d rather set aside time to do an in-depth discussion on those.”
Other prostate cancer specialists, however, say it’s not a question of whether to abandon PSA screening altogether but to find the most appropriate men to screen. After all, nearly 30,000 US men will die of prostate cancer this year, compared with nearly 40,000 American women who will die of breast cancer.
“The pendulum has swung too hard in one direction in favor of screening and now has swung too hard in the other, against,” said Dr. William Dale, chief of geriatrics at the University of Chicago Medicine.
Doctors probably don’t need to screen every man over 50, he added, but they should offer screening to those who are at increased risk because they’re African American or have a close family member who died of the disease.
Patient advocate Thomas Farrington, who lost his father and both grandfathers to prostate cancer, firmly believes that PSA screening saved his life when it led to his diagnosis of an aggressive cancer in 2000 at age 55. He founded the Boston-based nonprofit Prostate Health Education Network three years later, with a major focus on urging all African-American men — who are more than twice as likely to die from prostate cancer than whites — to have regular PSA screening beginning at age 40.
“There certainly is overtreatment for prostate cancer,” he said, “but we won’t solve it by sticking our head in the sand and ignoring the benefits of PSA testing.”
Another nuance that some doctors factor in to help patients make informed decisions: life expectancy. “Patients need to have at least 10 more years of life expectancy for them to benefit at all from cancer screening,” said Dale, who does regular assessments with his patients to help them determine which tests and treatments to have. He also found through his research that patients are pretty good at doing their own assessments.
In a study published this year in the journal Geriatric Oncology, Dale and his colleagues found that patients’ self assessments — such as poor, good, or excellent — correlated pretty closely with life expectancy tables and could be used to help patients make decisions concerning PSA screening.
Deborah Kotz can be reached at firstname.lastname@example.org. Follow her on Twitter @debkotz2.