Saturday, March 13, 2010

The Great P.S.A. Prostate Mistake: It's A Hugely Expensive Public Health Disaster Says Inventor

Richard Albin, the discoverer/inventor of the P.S.A. test in 1970, writes in the New York Times:

"Americans spend an enormous amount testing for prostate cancer. The annual bill for P.S.A. screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

Prostate cancer may get a lot of press, but consider the numbers: American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.

Even then, the test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.

I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."

18 Comments:

At 3/13/2010 7:15 PM, Anonymous DeeBee9 said...

The doctors cannot stop using the PSA test because if they fail to use it and a patient later is found to have cancer, the doctor will be sued. The facts don't matter in our legal system any longer.

 
At 3/13/2010 7:47 PM, Anonymous Stephen said...

I don't understand. Why aren't doctors telling their patients that it is a useless test?

 
At 3/13/2010 7:48 PM, Anonymous Stephen said...

DeeBee, can you point me to a single lawsuit that was successfully won where the facts didn't matter?

 
At 3/13/2010 8:30 PM, Anonymous Anonymous said...

US Lawsuits I can't quote Stephen but surely the OJ Simpson trial tells you everything you need to know about facts and the law?
PSA screening is promoted by the large gaping wallets of urologists.
Go ahead, make their day!

 
At 3/13/2010 9:38 PM, Anonymous Anonymous said...

I agree absolutely, the three percent of people that will die from Prostate Cancer should just suck it up, whining babies, how DARE they want to live when it is costing us BILLIONS!!

 
At 3/13/2010 9:44 PM, Anonymous DeeBee9 said...

Reply to Stephen: Let's see, a woman who regularly buys coffee from McDonalds, and therefore knows how hot it is, one day spill it on herself as she's driving. The hot coffee burns her and so she sues. The fact that she knew how hot the coffee was and the fact that she spilled it on herself while driving ought to have been enough to have the suit laughed out of court. But, no. The jury decided that McDonalds was at fault for providing hot coffee. How about the two geniuses who tried to trim a hedge by lifting a running rotary lawnmower up and running it along the edge. he mower fell an cut one of them. Do you think all the ridiculous warnings we see on every product these days ("Don't operate this appliance while standing in water", etc.) are there for the fun of it? The warnings are there because of the many times people have successfully sued when their own idiotic behavior caused them to be injured. For mediacl suits, look into how John Edwards made his fortune, suing Ob/Gyn's who had the misfortune of delivering less than perfect babies. The sad situation is that a jury will fall for the sob story, especially if they think that one of those evil insurance companies will be paying the bills. And, in almost all cases, companies will settle rather than take a chance on an irrational jury. The justice system has become a giant extortion machine. For a current case, watch what happens with Toyota and notice how many people suddenly remember how their Toyotas took off, causing their accidents. Look into the asbestos mess and see what's happened there. Watch the career of Erin Brokavich as she tries to find another case she can distort into millions of dollars.

 
At 3/13/2010 9:46 PM, Anonymous Anonymous said...

You socialist. You're suggesting that we look at the effectiveness of individual tests and procedures? Thank goodness the Republicans are fighting this.

 
At 3/13/2010 10:48 PM, Blogger B D Humbert said...

Dr. Perry,

I have for some time been arguing in other forums that even the TREATMENT of prostate cancer is probably a bad investment - most of us fortunate enough to live past 60 will die WITH prostate cancer - very few of us - I think the number is around 6% will die FROM this cancer.

Would seem to me to be a good research paper in waiting...

 
At 3/13/2010 11:30 PM, Blogger The Right Guy said...

A friend of mine had a PSA done at 45. It was 109. I wonder if it was a waste of time?

 
At 3/13/2010 11:37 PM, Anonymous Lyle said...

This and the recent mammography issue raise an interesting question, are we doing procedures because we can do them, without looking at the cost benefit ratios. In both cases there will be anecdotes about someone whose life is saved, which is fine, if you personally want to pay for the test, but if insurance or the government pays for the test the question is does the benefit exceed the cost? We used to bleed people to fix what ails them as well.
We need to apply the same standards to medicine we apply to engineering where safety is figured in as costs per life saved, and a limit is established on this. For example we could build cars out of carbon fiber that would allow one to walk away from a 100 mph head on collision (look at formula 1 cars for example) but they would cost a million dollars each, so we choose not to do so.
Clearly this does suggest that stopping reimbursement at 70 for example makes sense. Of course this makes us all confront the reality that we are going to die, there is no escaping it only postponing it.

 
At 3/13/2010 11:50 PM, Blogger The Right Guy said...

England does the same thing. After a certain age, you won't get treatment for things that you would in this country. I'll pass on medicine managed like that. I'd rather see the free market work. If you want it, pay for it (you can't do that with some socialized medicine). Having a government or company decide for you is stupid.

 
At 3/13/2010 11:51 PM, Blogger The Right Guy said...

PS, I can afford to pay for a PSA test if I want one.

 
At 3/14/2010 12:06 AM, Anonymous Stephen said...

DeeBee, the reason she won in that case is because it was determined that the coffee was hotter than a reasonable person would expect (it was essentially at boiling temperature). A reasonable person expects to get burned from spilling coffee on themselves, but not receive third degree burns by doing so, causing permanent scarring. These were the facts and why she won.

 
At 3/14/2010 6:57 AM, Anonymous MLRMD said...

Failure to diagnose cancer at a curable stage is one of the most frequent causes for medical malpractice suits. The PSA test was never meant to be a screening test. It was intended to help follow the progression of patients with known prostate cancer undergoing treatment. Since the mid-80's, however it has been used in conjunction with a digital rectal exam to try to find these cancers at an early curable stage. So far no one really knows whether it saves lives or causes more harm from the treatment (impotance,incontinance, and etc.).

The USPSTF (United States Preventive Tastk Force) concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years. The USPSTF recommends against screening for prostate cancer in men age 75 years or older. The USPSTF is the same group that got all the flak about mammography screening recently.
The AUA (Amrican Urological Association) believes that, "when offered and interpreted appropriately the PSA test may provide essential information for the diagnosis, pre-treatment staging or risk assessment and post-treatment monitoring of prostate cancer." The American Cancer Society gives a similar recommendation.
The bottom line is that each man should make an informed decision based on his own personal risks and desires after discussion with his doctor.
The problem that doctors have is that in most "communities" if you don't offer PSA screening and the patient is subsequently diagnosed with that disease that you didn't diagnose then there will be any number of experts willing to testify in court that you, the doctor did not follow the standard of care. Other experts will testify on behalf of the doctor that there is no such standard. The point is is that it leads to litigation, so it's in the doctors best interests and a lot easier to just order the PSA test instead of spending 30 minutes trying to explain the controversy to the patient. And the patient can always say at a later date the the doctor didn't really give enough information for the patient to make a truely informed consent.
So another example of how patients and doctors are trapped into the trial lawyers lock on how we have to lead our lives.

 
At 3/14/2010 9:28 AM, Blogger juandos said...

"The problem that doctors have is that in most "communities" if you don't offer PSA screening and the patient is subsequently diagnosed with that disease that you didn't diagnose then there will be any number of experts willing to testify in court that you, the doctor did not follow the standard of care. Other experts will testify on behalf of the doctor that there is no such standard. The point is is that it leads to litigation, so it's in the doctors best interests and a lot easier to just order the PSA test instead of spending 30 minutes trying to explain the controversy to the patient"...

Excellent point...

I mean consider the litigious John Edwards for instance...

 
At 3/14/2010 12:27 PM, Anonymous Anonymous said...

My doctor mentioned this issue and said it was up to me. He recommended not taking the PSA test unless we has a reason... history, digital exam, biopsy finding cancer, etc.... I'm 50. He said after the age of 60, your age is close to the % chance cancer cells would be found in your prostate if it was removed and analyzed (age 60 = 60% chance). The problem, "we can't differentiate between fast/slow growth cancer".

 
At 3/15/2010 9:55 PM, Anonymous Richard said...

PSA testing is only a mistake if you have not had prostate cancer. It is not a definitive test, but can give an early clue that something is wrong. I am willing to pay the price for the test. However, if we get Obamacare then the cost of a PSA test will be the subject of govt. policy and may be dictated by a bureaucracy that will decide what medical care is "necessary".

 
At 3/16/2010 12:11 PM, Blogger misterjosh said...

So what it comes down to is would I rather have a 13 % chance of undergoing debilitating treatment leaving me unable to control my bladder & with little sexual function, or a 3% chance of dying of prostate cancer.

I personally value quality over quantity, so I'll skip the test TYVM.

 

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