What do you get when you cross 3 pediatricians, 4 internists, 3 family doctors, 2 epidemiologists, 2 nurses, a PhD, an obstetrician, a perinatologist and an occupational medicine doctor? Unfortunately, this is not a joke. You get a Federal Government panel, given the imprimatur as experts on a medical subject that if any one of them individually treated, would be considered malpractice. This would be the U.S. Preventative Services Task Force (USPSTF), an ad hoc committee charged with making recommendations about clinical preventative services. They have just issued their findings that there is no role for routine PSA screening in men to detect prostate cancer. The real question is why do we need such an agency?
There are no doctors on this panel who treat prostate cancer. You would not go to a pediatrician or obstetrician if you had this disease, so how does it make sense to aggregate 16 such people and have them opine on a subject that they know about only from a book?
The conclusions of this committee were reached using a relatively new statistical gimmick called “meta-analysis”. This allows the pooling of small studies to create an enormous one with what statisticians refer to as “strength”, which is based entirely on large numbers of patients. It does not account for the quality of the study itself, and bad methodology of small studies can be concealed by pooling data, which is what happened here.
The American Urological Association (AUA)-the true experts in this area- has denounced these recommendations. It is particularly stinging that these recommendations were released during the largest meeting of urologists in the world- the AUA annual convention in Atlanta, where over a quarter of the program is devoted to discussion about prostate cancer. I know this is true because I attended it.
Some relevant facts about prostate cancer- it is the second most common cancer in men worldwide, but in the US. It is first, and is the second leading cause of death in men. Prostate cancer worldwide has the highest prevalence in the US, where it affects 125 of every 100,000 men, and in African-Americans it is 185. When compared to the rest of the world where PSA testing is not routinely done, the death rate from prostate cancer is the lowest in the US. Here, the 10 year survival of men with prostate cancer has risen from 53% in the pre-PSA testing era to 97% now.
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