Last month the American College of Preventative Medicine (APCM) stated that they no longer recommend prostate cancer screening with DRE (digital rectal exam) or PSA (prostate specific antigen). This new position statement was published in the February issue of the American Journal of Preventative Medicine.
Currently, a DRE and the PSA blood test are the principal screening tests for detection of asymptomatic prostate cancer. When the results of either of these tests are outside of the normal limits, additional testing is then used to determine the cause of the abnormal test results. With the high quality imaging used today, very little escapes medical surveillance. It is possible to detect even the smallest tissue abnormalities or cancerous growths. Therefore early screening with PSA and DRE can help to diagnose prostate cancer early, thereby potentially decreasing the mortality and morbidity associated with the disease. However, there is currently no conclusive data which demonstrates that early screening, detection, and treatment of prostate cancer actually reduces mortality. Here's a link to the research.
Not all aspects of early screening are positive. There are potentially adverse effects of early screening including increased anxiety, significant discomfort and possible complications from biopsy including pain, bleeding, and infection. Additionally, prostate cancer can be a slow growing disease which may never progress to cause significant disease or death. It is known that more men die with prostate cancer than of prostate cancer.
Additionally, men with slower growing cancers who receive conventional treatment may experience serious short-term and long-term adverse side effects such as pain, incontinence, and impotence. Treatment side effects are sometimes more damaging, and cause a significantly decreased quality of life, than the disease would have caused had it been left untreated by conventional methods.
It is because of these facts that the American College of Preventative Medicine concluded that there was insufficient evidence to recommend routine screening with DRE or PSA.
Instead of routine screening, clinicians should focus on educating patients about screening options. Doctors should provide information about the potential benefits and the risks of prostate cancer screening, and the limitations of current evidence for screening, in order to maximize informed decision making. This is especially true for African-American men and those with a family history of prostate cancer.
Both the ACPM and the American College of Physicians advocate that informed discussion about screening should take place annually, during the routine periodic examination, or in response to a request by a patient.
I often meet patients with many unanswered questions even their appointment with their physician. This seems to occur because of lack of appropriate time, or their doctor simply not answering all the patient's questions in an easily understood manner. It is essential that everyone with cancer gets all the information that they need to make the right treatment decisions. Decisions about cancer treatments should be made based on education, and not on fear- which is often the case.
It's a good idea to write down any questions you may have for your doctor before your appointment. Take this list with you, along with a pen and paper so you can write down the answers. Also, ask your doctor if they mind if you record your appointment so that you can review it later. I've never met a doctor who was opposed to this idea. Discuss your options with your support group, whether family or friends, and choose the path which makes the most sense to you. If you can't get the answers you need from your doctor, find another one.
Lastly, investigate your alternative and complementary treatment options. Most of the time treatments of this nature promote health, have no adverse treatment side effects, and, in the case of prostate cancer, can be very effective at halting and reversing the disease. It is also important to investigate your cancer promoting risk factors. Fighting cancer and ignoring any potential risk factors is like trying to stop your car while your foot is on the gas. Identifying, and then eliminating any risk factors is like stepping on the brake.
Until next time,
Jake Psenka, ND
0 comments:
Post a Comment