In an April 3, 2017, article for Forbes entitled “Guys: You Don’t Want That PSA Test For Prostate Cancer,” Steven Salzberg, Bloomberg Distinguished Professor of Biomedical Engineering, Computer Science, and Biostatistics at Johns Hopkins University, takes a firm stance against PSA blood test. His main arguments are a) more detection and early detection have not prevented deaths, b) aggressive treatments used in indolent cases have caused serious, life-altering side effects in 20-30% of patients who have elected radiation or surgery, and c) false-positives that approach 80% within the values of 2.5 to 4.0 ug/L.
First of all, Professor (of Biostatistics) Salzberg’s article is off on his statistics, quoting the American College of Physicians in writing that 1 in 16 men will be diagnosed with prostate cancer in their lifetimes. The original article written by the ACP and to which Professor Salzberg links has the correct number – that 1 in 6 men will be diagnosed in their lifetimes. Looks as though he confused 1 in 16 with the actual number of 16.7%.
Secondly, there is only one risk factor discussed in Professor Salzberg’s article – among 55-69-year-old men. The recommendation by the American Urological Association to focus on this demographic is dismissed by Professor Salzberg, who chalks up the it up to greed among urologists in dispensing PSA tests and following up on elevated PSA results that might – or might not – indicate prostate cancer.
Yet there are other risk factors not discussed by Professor Salzberg. He does not mention African-American men, who are diagnosed with prostate cancer and have a death rate that is more than twice that of the white population. And a family history among all races doubles the chances a man will be diagnosed, with the risk being even higher for men with a diagnosed brother than a diagnosed father (American Cancer Society). The risk is also much higher for men having multiple relatives diagnosed, particularly if those relatives were diagnosed at a young age (40-50).
Risk factors continue to point to higher rates of diagnosis and a higher percentage of aggressive, non-localized cases of prostate cancer among black men and among men with family histories. Fans for the Cure will continue to urge these groups to get regular screenings, as well as educating all men and their families to know the limitations of current testing methods so that they engage in informed decision-making about treatment plans. Our mission has expanded past the all-important early detection goals to include the protection of men with mild, localized cases from becoming part of the 20%-30% of men treated with radiation or surgery who go on to develop life-changing complications.
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Read the original article online: https://www.forbes.com/sites/stevensalzberg/2017/04/03/guys-you-dont-want-that-psa-test-for-prostate-cancer/2/#70aeb3ff308b
