Questioning Medicine: Prostate Cancer Screening (CME/CE)

“As prostate cancer awareness month just ended, prostate cancer screening seemed a fitting subject for this week’s blog.

“Those who know the evidence might think this argument pits European practices against our own domestic actions. Almost like a Ryder Cup for prostate screening. However, I recently saw that almost 50% of patients admit to undergoing lubed finger insertions and blood tests, which we know to be fairly inaccurate, in the last 12 months.

“In a Research Letter in JAMA Internal Medicine by Sammon et al., the fact that so many physicians are still screening for prostate cancer makes my evidence-based medicine soul cringe. In a 2012 survey, the authors found that among 114,544 respondents, 37% had undergone screening. Higher socioeconomic status nearly doubled a man’s odds of being screened (odds ratio 1.91, 95% CI 2.69-3.34).

“Prostate cancer screening has been placed in the no-go category by the U.S. Preventive Services Task Force and the Choosing Wisely campaign, as well as by many other major medical associations.

“Even the American Urological Association, which stands to lose the most money from reduced screening, states, ‘Men ages 55 to 69 … should talk with their doctors about the benefits and harms of testing ….’ In my opinion, they deserve a standing ovation for speaking to the evidence and not to the money, as the American College of Obstetrics and Gynecologists has with pelvic exams.”