GU Cancers 2019 | The harm-reduction approach to prostate cancer screening

So one of the big problems that we’ve had in screening for decades is that we’ve been screening the wrong men. So there’s been studies that have shown that if you’re a 78 year old man with three co-morbidities you have heart disease you have lung disease you have diabetes, you’re more likely to get a PSA test than if you were a healthy 54-year-old. Now the probable reason for that is that people aren’t thinking about giving PSA tests consciously. They’re just you know patient comes in and they need their cholesterol taken.

My goal is to a PSA test too. But obviously that’s completely the wrong way of doing it. If you’re going to give somebody a test for cancer that’s a big decision that has to be taken seriously and we should not be giving the PSA test to men who have absolutely no benefit. An older man who is sick is more likely to die of some other cause long before he would ever discover that he had cancer that would be screen detected. So we’ve been screening that’s the number one thing, we’ve often talked about the problem of PSA screening has been huge numbers of men over-diagnosed and over-treated. Some estimates that are since the introduction of PSA 1 million Americans have been over treated and over diagnosed, which is obviously a public health disaster. But what’s interesting is if you spit out the data almost all of that has been happening in older men.

We wrote a paper showing that if in 1987 the rules had been you can’t get a PSA test if you are 70 or older that would have reduced the amount of over-diagnosis by nearly half, 42 percent just that one plan. So we’re talking about this PSA screenings balance of harms and benefits. And here’s a very simple way that everyone agrees with we shouldn’t be screening older men. If we could actually implement that we would instantly decrease the harms but almost a half.