Archive for March, 2011

Back to the 1950s with New Prostate Guidelines

Posted on March 1, 2011. Filed under: Breast Cancer, Cancer, Preventive Care, Prostate, Recommended Medical Guidelines | Tags: , , , , , , , |

A new study on prostate biopsies from The Journal of the National Cancer Institute wants to take us back 60 years. The  study not only concluded that using PSA velocity for prostate cancer detection is ineffective and leads to “unnecessary” biopsies — but it also contends that all references to it should be removed from professional guidelines.

PSA (prostate specific antigen) is one way we can monitor prostate health. PSA velocity refers to the amount of change in a PSA from year to year. When doctors see a rise in PSA, they often order a biopsy. Granted, many prostate biopsies do turn out to be negative for cancer. But right now, there is no other way to determine if prostate cancer — whether it’s aggressive or non-aggressive — exists without a tissue diagnosis through biopsy.

The best way to determine whether or not a biopsy is necessary is by measuring PSA.  Waiting for a patient to exhibit symptoms of prostate cancer or to be able to detect a nodule by digital rectal exam equates to a later diagnosis, and if the patient does have cancer, it may be more advanced.

A similar problem exists for women and mammograms. In late 2009, the United States Preventive Services Task Force recommended shifting the age to start mammograms from 40 to 50, to reduce false positives that can lead to biopsies. A huge uproar ensued, leading to the American Cancer Society, among other organizations, continuing to recommended mammograms at age 40.

What’s lost in the uproar is this stark fact: These two cancers cause the second most common cancer-related deaths in men and women, and the only way we can ever hope to drop those alarming statistics down is by screening and catching those cancers early.  PSA is not perfect (nor is mammography), but both of those tests are the best means for detecting and intercepting potential problems.

Until something better comes along, it is in the best interest of potential cancer victims to implement screenings.  Not screening will result in the loss a huge number of lives.  Is it worth the cost savings of cutting back on biopsies?

One thing we can all agree on is that survivors of most cancers owe it to only one thing — “early” detection and treatment.

I have to add that on the medical malpractice side, the most common reason for damages is delay in diagnosis and treatment.  Juries will rarely be sympathetic to medical practitioners when all they see are delays that allow treatable cancers to become untreatable.

We have  to find better ways to screen and to do so affordably. Surely in 2011, we have the means to do that.

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