Why are so many men screened for prostate cancer when research suggests active surveillance instead?

When doctors don’t know, they test.

There is also something called best practices that different professions have developed to eliminate unneeded or potentially damaging procedures that are of little or no value if done routinely.

In chiropractic, best practices include being more selective about taking X-rays.  Compared to years ago when the standard of practice had to take x rays on everyone regardless of age, today, I select patients for X-ray only if there was trauma, the suspicion of cancer or organic phenomenon, or if the patient was older and the problem has been worsening over the years. In medicine, the findings and changes in expert opinion suggest that fewer X-rays should be taken, yet, going to the orthopedic with joint pain will likely result in an X-ray being taken regardless of best practices or the actual benefit derived. Doctors still order too many X-rays and MRIs in the absence of good exam findings which require better training than medical doctors receive in their internships or through continuing education at this time.  The result, of course, more tests due to inadequate skills in the diagnosis of musculoskeletal problems.

With regards to prostate screening, doctors would screen every patient for prostate and run the PSA test which is highly inaccurate in many cases and results in treatments resulting in incontinence or other unwelcome side effects.  Science tells us that most of these growths or cancers are slow growing and rarely life-threatening, which had the experts reevaluating the risk rewards of screening older men.

Currently, the recommendations suggest shared decision-making after age 69, taking into account age, life expectancy, other risk factors, and patient preferences. Men age 55 to 69 are advised to discuss the harms and benefits with healthcare providers before deciding to be screened.

The word cancer often results in patients making decisions that may not be rational considering the options for active surveillance have proven value.   Yet, still, 40 percent of those who are screened still have aggressive treatment as compared to 2010 when 90 percent did.

As with many things in healthcare, we know more now about what is appropriate and what is not in evaluating and considering the treatment of prostate cancer.

Data is not rational, its data and years of it are quite telling.  Emotions on the other hand can drive patients toward potentially damaging treatment options for growths in the prostate that are merely part of aging and are not an active or aggressive disease process requiring treatment that is more risky than active surveillance. The medical world continues to change as we know more but unfortunately, the treatment habits of many specialists have been frustratingly slow to change.

There is a long history of treatments that have little value after years of data such as shoulder impingement surgeries, many back surgeries, and even meniscus surgeries that even 12 years ago were commonplace.

According to the NY Times, prostate surgery is another one of those procedures that is aggressively treated, when better options that are not harmful are better supported by years of medical data.

Check out the article recently published in the NY Times

Too Many Older Men Are Still Screened for Prostate Cancer

Most have low-risk cancers and rarely benefit from treatment, a new study finds. Actively monitoring the condition is often the best choice.

By Paula Span May 8, 2023

Last summer, Joe Loree made an appointment to see his urologist. He’d occasionally noticed blood in his urine and wanted to have that checked out. His doctor ordered a prostate-specific antigen, or P.S.A., test to measure a protein in his blood that might indicate prostate cancer — or a number of more benign conditions.

“It came back somewhat elevated,” said Mr. Loree, 68, an instructional designer who lives in Berkeley, Calif. A biopsy found a few cancer cells, “a minuscule amount,” he recalled.

Mr. Loree was at very low risk, but nobody likes hearing the C-word. “It’s unsettling to think there’s cancer growing within me,” he said.

But because his brother and a friend had both been diagnosed with prostate cancer and had undergone aggressive treatment that he preferred to avoid, Mr. Loree felt comfortable with a more conservative approach called active surveillance.

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