Medicine
Previous studies found that two-thirds of men who receive prostate-specific antigen (PSA) screening for prostate cancer didn't have shared decision making with their physicians. If shared decision making occurred at all, patients were more likely to remember hearing about the advantages than the disadvantages of PSA screening, and many older men with a high probability of death within the next 9 years were screened nonetheless.
These findings, along with a Cochrane review and another systematic review (that I co-authored) which both found no pooled mortality benefits in several randomized controlled trials, led the U.S. Preventive Services Task Force to recommend against PSA-based screening for prostate cancer in 2012. Since then, the American Academy of Family Physicians and the American College of Preventive Medicine have added this service to their Choosing Wisely lists of tests and procedures that patients and physicians should question.
The Medicine By the Numbers published in the May 1st issue of American Family Physician clearly illustrates that the harms of PSA screening exceed the benefits. 1 in 5 men who received PSA screening ended up undergoing a biopsy for a false-positive test; 1 in 34 and 1 in 56 screened men, respectively, suffered erectile dysfunction or urinary incontinence as a result of prostate cancer treatment. In contrast, PSA screening prevented zero deaths from prostate cancer or all causes. In other words, no benefits.
This review begs the question of why clinicians should bother with shared decision making in most average-risk men, rather than simply telling them that this test is a bad deal.
**
This post first appeared on the AFP Community Blog.
- We Need To Know More About Psychological Harms Of Screening
Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with...
- Shared Decision-making For Lung Cancer Screening: Will It Work?
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) officially proposed coverage for annual low-dose computed tomography (LDCT) screening for lung cancer in current or former smokers age 55 to 74 years with at least a 30 pack-year...
- Rethinking Shared Decisions In Prostate Cancer Screening
Last October, the U.S. Preventive Services Task Force provisionally recommended against screening for prostate cancer using the prostate-specific antigen (PSA) test, eliciting a variety of reactions from medical and patient advocacy groups. The New England...
- Challenging Conventional Clinical Wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence...
- What Is "too Much" Health Care?
At first blush, inappropriate health care sounds like a contradiction in terms. Isn't "care" by definition something that is necessary and appropriate, and if so, how is it possible to get too much? Such talk inevitably invites accusations of "rationing,"...
Medicine
PSA screening by the numbers: no benefits, many harms
Previous studies found that two-thirds of men who receive prostate-specific antigen (PSA) screening for prostate cancer didn't have shared decision making with their physicians. If shared decision making occurred at all, patients were more likely to remember hearing about the advantages than the disadvantages of PSA screening, and many older men with a high probability of death within the next 9 years were screened nonetheless.
These findings, along with a Cochrane review and another systematic review (that I co-authored) which both found no pooled mortality benefits in several randomized controlled trials, led the U.S. Preventive Services Task Force to recommend against PSA-based screening for prostate cancer in 2012. Since then, the American Academy of Family Physicians and the American College of Preventive Medicine have added this service to their Choosing Wisely lists of tests and procedures that patients and physicians should question.
The Medicine By the Numbers published in the May 1st issue of American Family Physician clearly illustrates that the harms of PSA screening exceed the benefits. 1 in 5 men who received PSA screening ended up undergoing a biopsy for a false-positive test; 1 in 34 and 1 in 56 screened men, respectively, suffered erectile dysfunction or urinary incontinence as a result of prostate cancer treatment. In contrast, PSA screening prevented zero deaths from prostate cancer or all causes. In other words, no benefits.
This review begs the question of why clinicians should bother with shared decision making in most average-risk men, rather than simply telling them that this test is a bad deal.
**
This post first appeared on the AFP Community Blog.
- We Need To Know More About Psychological Harms Of Screening
Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with...
- Shared Decision-making For Lung Cancer Screening: Will It Work?
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) officially proposed coverage for annual low-dose computed tomography (LDCT) screening for lung cancer in current or former smokers age 55 to 74 years with at least a 30 pack-year...
- Rethinking Shared Decisions In Prostate Cancer Screening
Last October, the U.S. Preventive Services Task Force provisionally recommended against screening for prostate cancer using the prostate-specific antigen (PSA) test, eliciting a variety of reactions from medical and patient advocacy groups. The New England...
- Challenging Conventional Clinical Wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence...
- What Is "too Much" Health Care?
At first blush, inappropriate health care sounds like a contradiction in terms. Isn't "care" by definition something that is necessary and appropriate, and if so, how is it possible to get too much? Such talk inevitably invites accusations of "rationing,"...