Apr 30, 2017
In this episode I interview for a second time one of my partners Dr. Peter Sershon. Dr. Sershon has made a name for himself both as a cancer specialist as well as a robotic surgeon within our community. He and I have operated together at least one day a week for nearly ten years. Occasionally a surgeon finds himself the couple of hours to spare when an operation has to cancel at the last minute for medical or other reasons. Such was the case the other day when we found an hour of spare time one morning when a gentleman with prostate cancer had to cancel his operation at the last minute due to an unexpected problem with his heart. We decided to find quiet room in the hospital (which can be difficult) and sit down to have a conversation about the United States Preventive Services Task Force considering a change in their rating for prostate cancer screening using the PSA test from a “D” rating to a “C” rating. This is effectively a change from a recommendation against using PSA to screen for prostate cancer to a neutral rating on PSA screening where it is recommended that men who are age 55 to 70 have a discussion with their physician regarding PSA screening. Although this is a positive change overall there are many in the urologic and oncologic communities who don’t feel that the recommendations are going far enough to help those men at higher risk of prostate cancer morbidity and mortality, specifically African-American men and men with a family history of prostate cancer. The PSA test is a protein made in normal and prostate cancer cells. It can be detected in the bloodstream and measured accurately. Most men have low PSA reading. When the test is higher there is a risk that man has prostate cancer. But normal tissue can also elevate the PSA test in the bloodstream as the prostate gets larger or if there is an infection or prostate inflammation. When a PSA test is elevated a man needs further testing to determine if that elevation represents cancer. Furthermore, most prostate cancer is slow growing and for many men not life-threatening. There is a risk of over-treating some men with slow growing prostate cancer when an elevated PSA test leads us to find a cancer that would otherwise not become a problem for a man and may otherwise have gone undetected. PSA screening can lead to worry, further testing, over-diagnosis and over-treatment. On the flip side, however, PSA screening is often the only way to detect prostate cancer early for those men who may have a faster growing, life threatening prostate cancer. We can only cure those cancers we detect early, before they have escaped the prostate. Not screening men with a PSA test often leads to under-diagnosis and under-treatment. It would be great if the PSA test were only elevated in the case of cancer, but it elevates for non-cancerous reasons as well, so the question of “to screen or not to screen” is not going away. At least the USPSTF is considering changing its rating to a “C,” which should empower a man to get the PSA if he so chooses. As a physician who treats prostate cancer I wanted to sit down with one of my partners who was also cast in the role of caring for these men to get his or her opinion. When Dr. Sershon and I found a few spare minutes I grabbed a small, portable recorder and we tried to find a quiet place to sit, have a cup of coffee, and talk. The sound quality came out better than I expected although you can hear some background noise. I thought I would pull just a couple of minutes of highlights from our conversation but I have elected to keep the interview almost in its entirety and only lightly edit it. In listening to it I found we veered off track at times, but I think we had a good conversation and you will enjoy listening to it. Time for commenting on the proposed change by USPSTF is open until May 8th on their website (link below). You can make comments even if you are not a medical professional and I would encourage you to do so. If you feel strongly about prostate cancer screening and want to advocate for it please share this podcast episode and the link below with others. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/prostate-cancer-screening1?isCommentThanks=True Thank you for listening to this episode. If you are a man between the ages of 55-70, or are African American or have a family history of prostate cancer please discuss the PSA test with your physician. Have a healthy day.