LETTER
Early Detection of Prostate Cancer
Stephen L. Winters, MD
15 October 1997 | Volume 127 Issue 5 Part 1 | Pages 656-657
TO THE EDITOR:
The recently published clinical guidelines for early detection of prostate cancer [1-3] deserve unprecedented recognition. As a physician, I recently had to direct my 72-year-old father through appropriate counseling after low-grade prostate adenocarcinoma was diagnosed from biopsy specimens obtained as a result of prostate-specific antigen (PSA) screening. Fortunately, physicians with impeccable experience and integrity and outstanding communication skills have helped guide him. Unfortunately, most patients do not have the benefit of a family member or advocate who can seek unbiased opinions. Such persons may therefore be unnecessarily subjected to a physician's attitude that once the disease is diagnosed, some form of intervention is imperative. Rarely do physicians have the time to explain the intent and ramifications of screening methods such as measurement of PSA levels. Coley and colleagues [3] unfortunately hedge in their recommendations with regard to men older than 70 years of age. They point out the absence of any documented benefit to such screening and suggest minimal gain in productive longevity from available treatment options. In addition to the potential impact on physical well-being, the authors do not address the psychological effects that such diagnoses may have on patients [4]. Because data on any true benefit from such screening are lacking and patient advocates are too often unavailable, a strong case should be made for recommending that screening in older age groups be abandoned unless undertaken as part of upfront controlled trials.
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Author and Article Information
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Morristown Memorial Hospital; Morristown, NJ 07962-1956
1. Coley CM, Barry MJ, Fleming C, Mulley AG. Early detection of prostate cancer. Part I: prior probability and effectiveness of tests. Ann Intern Med. 1997; 126:394-406.
2. Coley CM, Barry MJ, Fleming C, Fahs MC, Mulley AG. Early detection of prostate cancer. Part II: estimating the risks, benefits, and costs. Ann Intern Med. 1997; 126:468-79.
3. American College of Physicians. Screening for prostate cancer. Ann Intern Med. 1997; 126:480-4.
4. Kornblith AB, Herr HW, Ofman US, Scher HI, Holland JC. Quality of life of patients with prostate cancer and their spouses. The value of a data base in clinical care. Cancer. 1994; 73:2791-802.
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