On May 22, an area newspaper published a syndicated commentary written by Dr. Virginia A. Moyer that criticized routine screening for prostate cancer. Moyer, an academic pediatrician and chair of the U.S. Preventative Services Task Force, mentioned in her commentary that "screening men of any age for prostate cancer using the prostate specific antigen (PSA) blood test" is not recommended. She goes on to mention that "many men are harmed as a result of prostate cancer screening" and that screening is not recommended because only "one man in 1,000 screened will avoid death from prostate cancer."
This logic is astounding to us as urologists caring for the people of the Mahoning Valley. We cannot feel more strongly that these recommendations will harm men in our area and feel compelled to rebut the claims of the USPSTF. The disease of prostate cancer is not the same from one man to another and thus making a claim that applies to all men is wrong. We do acknowledge that there are some forms of prostate cancer that do not require to be treated. However, in our work as doctors on a daily basis we, unfortunately, see men who were not diagnosed with prostate cancer in time and will therefore die from this disease. The academic and theoretical world is often much different than the practical world, and to generalize that this disease is nonlethal and does not need to be found early is extremely irresponsible and dangerous of Dr. Moyer and the USPSTF.
Since the introduction of PSA in 1986, the overall death rate from prostate cancer has declined significantly - up to 40 percent in some studies. In short, early detection saves lives. Even if it were only one life in 1,000 as claimed by Dr. Moyer, that one life can be, and absolutely should be, saved very easily. The USPSTF report quotes studies and makes the assumption based on these studies that prostate cancer screening does not save lives. Many of the studies mentioned have innumerous flaws and the conclusions of these studies are based on bad science.
One study was designed in 1990 and compared those who were screened and those who were not. However, the "unscreened" group was, in fact, truly screened and this contaminated and skewed the results making it appear that screening does not make a difference. Another study performed in Europe did show that screening for prostate cancer does save lives but the USPSTF did not include the update to this study in their recommendations. Thousands of articles have been written regarding the extremely complex and controversial subject matter of prostate cancer screening and treatment. Despite these studies, there still exists controversy. Until the time that this issue is definitively resolved and better tests become available, doctors should continue to utilize the current methods of screening for prostate cancer to allow for detection in the earliest possible stage.
Men at highest risk for prostate cancer are those men with a family history of prostate cancer, veterans who were exposed to Agent Orange in Vietnam, and African Americans. However, all men are at risk for developing prostate cancer within their lifetimes. In accordance with the American Urological Association guidelines, we recommend that all men discuss the pros and cons of prostate cancer screening with PSA with their physician and strongly urge these men to have an annual PSA and digital rectal examination beginning at the age of 40. This approach has saved many men's lives in the Mahoning Valley. Without PSA and early detection of prostate cancer we will see more men who present to our offices who we can do very little to help.
Daniel Ricchiuti, M.D.
(This letter was signed
by 13 other doctors)