Recently the AUA has announced a change in its position on PSA screening in the general population. They can be read here: http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm .
This indeed is a radical departure from previous positions as recent as 2009 but going back almost 20 years. Can a Supertanker turn on a dime and if so why?
In retrospect, there is no doubt in my mind that the medical community has been over aggressive in screening for prostate cancer and treatment of prostate cancer. Patients have been exposed to potential harm, have suffered painful tests and experienced emotional agony.
There is also no doubt in my mind that lives have been saved and lives have been improved as a result of prostate screening and use of PSA.
The controversy leaves us naked. If we shouldn’t rely on PSA and early detection, then what should we do? These guidelines tell us what not to do but it doesn’t tell us what we should do. The fact remains that prostate cancer is the second leading cause of cancer deaths in men. So we can’t just walk away from this and say “PSA is useless” or “there is no use or prostate cancer screening or detection”. There must be a reconciling of prostate cancer lethality and a means of detecting and treating it before it kills. So I suggest that this has not been played out yet and is an act in motion.
More needs to be learned about the natural history of prostate cancer to determine which are lethal cancers and which are indolent. We need better tools to detect the lethal cancers while they are still treatable. In the mean time we need to rely on what we have, take into account recent studies (flaws and all) , meta-analysis and guidelines and uphold the dictum of “first do no harm”.
E. Dula, M.D., FACS
July 13, 2013
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