Prostate Cancer Screening

The medical community is like every other profession–far too certain about the state of its knowledge and lacking humility about past mistakes.  The profession, really various specialty societies, is constantly issuing guidelines for care of various diseases and conditions and then having to revise those when it turns out the guidelines were causing harm.  Two common examples are constant revisions to blood pressure control guidelines and blood sugar level guidelines.  They get set too low and then people suffer the consequences of either too low a level or adverse drug events from trying to get to the recommended level.

Here is another awful example, backed up by recent research.  Prostate cancer is a very common occurrence in men, especially older men.  It manifests in a variety of forms.  Often, it is a very slow growing tumor that never reaches real clinical significance.  Other prostate cancers are very aggressive, spreading rapidly.   For decades men of a certain age were recommended to get regular prostate cancer screening, by the PSA test.  Then the “experts” decided that too many men were being diagnosed with a prostate cancer that was unlikely to ever spread or cause serious problems, and that men were getting surgeries and other treatment that was unnecessary.  So they stopped recommending regular screening for all men.  The outcome was pretty obvious–more prostate cancers were discovered at a later stage and more deaths occurred.

This study, reported in the New England Journal of Medicine, involved a very long-term follow-up of men who did and who didn’t receive regular PSA screening.  Over the 13 year follow-up period, men who were screened had 13% lower mortality.  They also likely avoided all the treatment issues associated with more serious prostate cancer.  (NEJM Article)

Now there is another interesting angle to this story.  The medical community engaged in blatant sexism in how it treated this exclusively male issue.  Can you imagine the outcry if there was any recommendation to lessen screening for female breast cancer?  This is part of the general lack of attention paid to male health issues.  And men paid the price for the hubris and sexism of the medical profession.