The limits of cancer screening continue to emerge. In addition to the USPSTF rejection of PSA tests for prostate cancer, the NYTimes offered a story this weekend with the headline — Can cancer ever be ignored? Today, the paper features a blog post with the headline “The Shortfalls of Early Cancer Detection” and an editorial entitled “Questioning Prostate Cancer Tests.”
Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients. They have already been held up for two years lest they ignite charges of government rationing. That’s absurd. The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.
But, on the letters page, MGH’s Dr. Donald Kaufman defends the tests:
Used correctly, the P.S.A. test is invaluable. It allows us to identify men who merit a biopsy. A biopsy that reveals cancer should not trigger a radical prostatectomy, with its potential for dire, life-changing side effects. Rather, it should lead to a discussion between doctor and patient and a careful analysis of whether any treatment at all is required.
Active surveillance should always be considered before any treatment is advised. Many men with proven cancer will never require treatment.