Once again the USPSTF expert panel recommended against common sense behavior of practitioners by recommending against the use of screening PSA's arguing that the bad results of unnecessary treatment of cancers with a benign prognosis outweighed potential benefits of finding and treating lethal tumors at a more advanced stage.
Ordinary "non-expert" doctors in the trenches inherently felt that a simple test that occasionally led to sparing a patient from the gruesome outcome of a fairly common male cancer was a good idea. Academics, who often favor society oriented consensus type medical practice, disagreed. I noted one editorial comment in one of the major journals (which I won't take the trouble to dig up now) that noted stubborn persistence in ordering the test by family doctors who really weren't expert enough to make a critical judgment and who probably should be excluded from being able to order the test.
At the time it struck me as the height of folly to recommend against collecting patient data. If a test is accurate (that is produces reliable reproducible results), is easy to do and harmless and can find significant disease that would otherwise not be readily detectable, then it is information that is worth obtaining. The fact that we sometimes or even often use the information inappropriately is irrelevant, since over time the medical community can certainly learn to manage the data. In fact it was clear to me in real time out in the field that my urology colleagues were doing just that and I was seeing more and more patients being managed with watchful waiting. Most of my patients were comfortable with that advice and were not unnecessarily anxious about the situation.
It seemed to me that the USPSTF experts were once again guilty of static analysis, that is making judgments based on past data as if medical practitioners in the field were frozen in their behavior and not would stubbornly and stupidly fail to adjust their patient management based on ongoing experience and up to date information.
Sure enough we now have a study which shows an abrupt decrease in diagnosis of prostate cancers promptly after the USPSTF announced its recommendations. Apparently their influence on practice behavior is potent, as one might expect with a group that carries an aura of government authority. The reduction in diagnosis includes later stage cancers as well as early, so indeed society based medicine is content to let some men die with widespread painful bony metastases for the good of the whole.
As for me I'll continue to get my yearly PSA, and continue to advocate getting government out of medical practice!!!
