AUA 2012 - Perspectives from the AUA - PSA controversy: Do the harms exceed the benefits or the benefits exceed the harms? - A take-away message for urologists

ATLANTA, GA USA (UroToday) - The USPSTF recommendation to cease all PSA screening in all men of all ages was the buzz at AUA this week.

Dr. William Catalona fielded many questions from the media on behalf of the AUA and urologic groups who all maintain a united front that PSA testing should not be eliminated as a screening test for prostate cancer.

“The reaction among urologists is an overwhelming majority feel this was unwise, unfounded, and really misinformed,” said Dr. Catalona. “Many believe the USPSTF has overestimated the harms of screening and underestimated the benefits of screening. The question is, do the harms exceed the benefits or do the benefits exceed the harms?”

In a paper (Abstract 416) presented at AUA meeting by New York University researchers, they evaluated the tweets from the USPSTF announcement for 20 hours after. Of all the tweets analyzed, 90 % expressed no opinion. Of the 10% with an opinion, approximately 3-to-1 favor screening.

What do physicians tell their patients? “The great consensus among urologists is the patients should be allowed to make a decision for themselves. It is highly desirable to discussing the potential risks and benefits of screening and if the patient wishes to proceed, then a PSA test should be given along with a digital rectal examination.” “I hope the task force recommendation will not affect healthcare insurance coverage for patients. A lack of coverage would adversely affect the poor, including many African American men who have a 50% higher risk for developing prostate cancer and a 200% higher death rate from prostate cancer.”

catalona wm aua2012Dr. Catalona was encouraged that last year President Obama, for his annual physical, did request a PSA test and said that the government would not discontinue insurance coverage for PSA testing.

Existing studies will mature and there will be more evidence on this issue, “I recommend physicians follow the research and stay in close dialog.” There is no alternative to screening with PSA -- it is the only thing out there to allow us to detect prostate cancer in its early form. Dr. Catalona believes without it, prostate cancer deaths would increase dramatically. “Then we would go back to a time when prostate cancer patients presented with metastatic disease from the beginning. We don’t want to go back there --no one wants to go back there.“

Reported by Karen Roberts, Medical Writer at the American Urological Association (AUA) Annual Meeting - May 19 - 23, 2012 - Georgia World Congress Center - Atlanta, GA USA

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