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    Men must be entitled to PCa screening, treatment choice

    Editor's note: The following letter was sent to Urology Times in response to a previously published letter to the editor, "Dear USPSTF: Don't discount value of PSA in men 70+."

     

    To the editor:

    The letter from Navin Shah, MD, and Vladimir Ioffe, MD, in the July 2017 issue of Urology Times was an excellent discussion of some of the reasons why the USPSTF recommendations have had a negative impact on prostate cancer diagnosis and treatment. I know of no other [recommendation], which is based on flawed data, with cross contaminations, that has had a more negative impact on men’s health.

    Men have the right to know if they are at risk for prostate cancer and should have the opportunity to decide if they should be screened and diagnosed. In addition, it should be up to them and their physicians to decide on treatment, not a third-party payer. All of this is about a simple blood test that costs only $28.

    Read: Most robotic RPs performed at low-volume hospitals

    All of us treating these patients know that we are seeing later stage, higher grade disease, as Dr. Shah and Dr. Ioffe have demonstrated. We all know how hard it is to get men to be seen by a physician. We all know how much more difficult it is to treat late-stage prostate cancer.

    Men are the worst patients, who avoid seeing doctors at all cost. We all know that this is just an issue about denying care and not spending money on treatment. Imagine, if patients had annual PSAs and physical examinations, how many patients we could help. Oh yeah, we did that experiment and have proven in study after study how beneficial this can be.

    Next: "The whole idea put out by the USPSTF in 2012 was flawed from the outset"

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    • UBM User
      Dr Beaghler is correct in as much as he states that PSA is not a great screening test for prostate cancer. The fact that only costs $28 is irrelevant. Epidemiologists will tell you that for a screening test to be of value it has to improve overall survival not just disease specific survival. There is no evidence that PSA screening can do this not even from the large European study (although strictly speaking, large as it is, it is not powered to do this). All this and we haven't even got on to the topic of over diagnosis and over treatment. Yes, men have a right to know but this starts right at the PSA test where advice needs to be given; not with the casual "let's have a PSA test and see how things are" approach. Finally, whatever advice is given needs to be from institutions where there is clearly no conflict of interest in the outcome.
    • Anonymous
      Dr. Beaghler is correct men should always have the right to know. It's their body and their life. He make a comment on how hard it is to get men to go to the doctor. From a patient point of view one of the reasons we stay away is due to a lack of privacy when it comes to intimate care, exams, tests, and procedures. A man's privacy rarely protected nor his dignity respected by today's healthcare system. They are running the business like it was the early 20th century when in their opinion men weren't modest. Today men are modest an the healthcare system needs to acknowledge that fact and better protect their male patients rights. Many men believe it or not would feel more comfortable with male caregivers especially in a urological related exam, test, or procedure. If a woman can have a female mammographer do her mammogram, then a male should be able to without question have a male sonographer do his testicular ultrasound. Like the scales of justice, the scales of our healthcare system must be balanced so that both men and women get the care they need. Currently the scales in healthcare lean far in favor of women. Physicians need to advocate better for their male patients in order to balance the scales again. Why do you think men are dying so young. It's because of the way they are treated when they go for care. They'd rather stay away after their first exposure to the system rather than hand over their respect and dignity at the door the way the healthcare system wants them to. If you want men to come back start treating them as people not objects. Regards, John

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