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Old April 23rd, 2003, 16:07
searoemer searoemer is offline
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Join Date: 2003
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prostate screening

I am really mad about this important subject being sullied by the political and economic mess called American Business. The only worse mess is the world of medical research funded by public health interests.

We know enough now to start screening for prostate cancer:
Please see Arnold Bullock M.D. and Gerald Andriole M.D. chapter on screening in 2002 edition of the text Prostate Cancer. The gold standard text being used in medical schools. They say in their summary:
"...the standard strategy of annual PSA screening beginning at age 50 years appears to be less effective and more resource intensive compared with a strategy that begins earlier but screens biennially instead of annually. …Etzioni concluded that biennial screening is a cost-effective alternative to annual screening for prostate cancer…. biennial screening with PSA greater then 4ng per mL was projected to reduce the number of screens and false-positive tests by almost 50%, relative to annual screening, while retaining 93% of years of life saved…Screening will identify some men with cancer who will not benefit by treatment. Although it is yet proven whether screening would be followed by a reduction in morbidity and mortality, recent data suggest a screening effect has been observed in the United States with an increase in incidence, a decrease in men with distant metastases, and a small decrease in prostate cancer mortality. Page 206
isbn 0-7817-2006-0

The problem is evidence based medicine does not recognize the value of the DRE. When you do a rectal exam you ask a lot of questions about genital function that normally do not get talked about. Even if the DRE is negative, and 95% of the time it is, you have a chance to get the guy thinking about prostate health and the need to think about diet and PSA.

This physical exam is also the time for the doctor to start using his diagnostic wisdom and try to anticipate a problem. Lets give the US Preventive Task Force a break ---they are making suggestions---not rules. Besides I am willing to bet there is not a good diagnostician in the whole bunch. Folks who achieve success in these sort of committees have different skills and probably should refrain from making clinical policy in an area that is more art then science.

While I am on a roll what do you suppose homophobia and the number of female nurse practitioners have to do with the reluctance to test for prostate cancer? Could it be true that are enlightened clinicians just don’t want to get their hands and minds dirty?
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