Should Obama Get a PSA Test? On Prostate Cancer Screening and Comparative Effectiveness

Reader Comments
Back to blog

I am having a otugh time readign ehalth.usnews.com in eSaMonkey 6.3, I juyst thoought I might tell you aboutf it!

seo lace of AL 11:56AM May 02, 2010

I am having a helll of a tmie seeing your apgbe in Firefox 9., just figured I might let you know?

seo lace of AL 11:56AM May 02, 2010

after my zolodex shot why does my psa move up and or down?

howard e becker of IL 12:22PM September 03, 2009

Hi!vjjr! http://hnbtszix.com iyhwh jezwt

Aboutbwyvb of AR 9:10PM June 05, 2009

Finally, a column that makes sense. Thank you Dr. Healy, especially for pointing out that the screening techniques in the "new" studies are already obsolete so even once the results are complete in another 10 years, they will be of historical, not medical, value. Hopefully this round of controversies will result in more men knowing more about their prostates, and how to deal with prostate cancer. Or perhaps the anti screening forces would have us men believe that it's better to not even know about prostate cancer -- as we might be caused undue worrying.

Robert l Smith of NY 2:27PM April 14, 2009

A few comments to clarify some of the readers concerns:
First: Mortality rate was calculated by the number dying from prostate cancer as a percent of the total number of healthy men screened -- compared to the number dying of prostate cancer in the unscreened control group Five or ten year survival rates might look artificially better because of early detection, but not mortality. Also, in the US we have seen a fall off in the absolute number of men dying of prostate cancer, despite a larger and older population.
Second: Prostate cancer is generally slow growing and one would not expect to see much of a mortality difference until after ten years. These were interim reports. The studies are on going and trends in the European study suggest, at least, that mortality differences will widen -- with the screened group continuing to do better.
Third: Yes, the complications that can be associated with treatment of prostate cancer can be serious and affect quality of life. And every prostate cancer does not need aggressive treatment. For those that do need therapy, the side effects must be understood, but also put in context of the symptoms of advanced prostate cancer as it spreads locally, affecting bladder, bowel and sexual function, and spreads to bone and other parts of the body.
The decision to be screened or not is entirely up to the patient, as it should be. And therapy, if prostate cancer is present, should be as well. The information that will help doctors make recommendations and patients make choices is what these and other studies are about. They need to be looked at in detail and not be dismissed with headlines that can often be misleading, if not wrong.

Bernadine Healy MD of DC 2:18PM April 05, 2009

The most sobering piece of information isn't simply that 48 men would need to be 'treated.' 48 teated men would risk side effects such as urine incontinence and impotence when treated with surgery, and with painful defecation and chronic diarrhea when treated with radiation. I'm shocked that Dr. Healy doesn't mention this at all in her article. That she does mention the 20% reduction in mortality, without mentioning what the mortality rate is, I also find shocking. The number was small - for every 10,000 men screened there were seven fewer deaths after nine years. None after ten years. Why do doctors pretend that their patient should make the decision, when they are clearly biased and don't give them all the information?

M.I. Amendolia of NY 1:08AM April 05, 2009

I think it's really good because it's the big things in usa

Sun Jingce of GA 9:21AM April 04, 2009

Dr. Healy states that "...In contrast, based on the same body of research, urologists and cancer groups recommend routine screening for men over age 50 and in the 40s for those at high risk, including African-Americans and those with a family history of prostate cancer."
Other than the American Urological Association and few other trades groups, I don't think any credible cancer groups have embraced routine PSA screenings for average risk men in the US. I think they emphasize shared decision-making and provide a very nuanced view-- both in terms of screening & treatment for localized prostate cancer.

Roshan of MN 12:56AM April 04, 2009

Dr. Healy states that "...In contrast, based on the same body of research, urologists and cancer groups recommend routine screening for men over age 50 and in the 40s for those at high risk, including African-Americans and those with a family history of prostate cancer."
Other than the American Urological Association and few other trades groups, I don't think any credible cancer groups have embraced routine PSA screenings for average risk men in the US. I think they emphasize shared decision-making and provide a very nuanced view-- both in terms of screening & treatment for localized prostate cancer.

Roshan of MN 12:54AM April 04, 2009