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I have written before about the uselessness of screening for prostate cancer in the past, which brought on the vitriole of some of my fellow MD bloggers, some of whom had vested financial interests in the perpetuation of this looney practice. But now we have none other than the inventor of the Prostate Surface Antigen (PSA) test, Richard Ablin, coming out to say today in an editorial that it is not only useless, but a public health disaster. He points out that 16% of men will be diagnosed with prostate cancer, but only 3% will die of it. The PSA is used to drive men with mildly elevated values into the medical machine that will leave them with medical bills, possible impotence and urinary problems. In spite of this, PSA testing was not shown to save lives in a US study I wrote about last year here.
In the editorial he writes:
I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.
In the heat of the moment around healthcare reform maybe we should pay attention to this instead of Billy Tauzin’s whining? Anyone listening?
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Why in the world do doctors prescribe these useless test? Are they ignorant of their efficacy or are they simply motivated by money? Why don’t doctors hold their peers to higher standards?
Here’s a scenario for Paxz
MD – ….NNT, false positive/false negatives, NNH blah blah blah so Mr. Smith I really don’t think prostate screening tests are likely to be useful (now MD is 30min late for next appointment having spent time explaining this but will not be paid extra)
Patient – But doc, my neighbor died of prostate cancer and his wife said he would still be alive if he’d had that test. Plus my insurance covers it anyway. And how do you know if I’ll die with prostate cancer or from it?
MD – (sees visions of angry family and malpractice lawyers with expert witnesses) Here’s your lab slip Mr. Smith.
PSA is only part of the story with urologists. anything above a 4.0 with a psa test, and that person gets a prostate biopsy, which is very invasive.
Urologists also of course do urinalysis on every patient they see. if that urine sample shows even microscopic hematuria, that person gets a cystoscopy, which is minor surgery, and very unpleasant.
Diagnostic testing makes this specialty rich.
We need a better diagnostic test for prostate cancer. With a PSA level of over 10.0 my biopsy proved negative for cancer. However it remains high but my consultant does not know why. I am on ‘watchful waiting’ so if it rises there are more biopses until something is found. I may already have cancer but it is like hunt the thimbal. I pray a more accurate test comes soon.