By Scott Eggener, MD
While PSA screening for prostate cancer continues to be a controversial topic, it’s still a potentially life-saving procedure when used effectively.
We have two abstracts at this year’s ASCO meeting that look at who is getting PSA tests and what is being done after the diagnosis of prostate cancer.
In many ways, those two questions are at the heart of the ongoing controversy.
In one of our abstracts, we analyzed data from the 2005 and 2010 United States National Health Interview Survey and found that 25-45% of older, sicker men continue to get PSA screening despite recommendations against such screening.
“Even among men with a low-likelihood of living nine years, a good percentage of them are still getting the PSA test,” said Michael Drazer. Dr Drazer is an internal medicine resident at the University of Chicago and has contributed to previous work on this topic.
Practice patterns did not show any meaningful changes based on a 2008 recommendation to limit screening in men over the age of 75.
The equally important flipside to this study is that young, healthy men, who have a life expectancy measured in decades and who are most likely to benefit from PSA screening, are not getting the test in sufficient numbers.
Either these men are not going to their physician regularly, it is not being offered to them, or they chose not to have the test.
Our second abstract, spearheaded by Ya-Chen Tina Shih, PhD, an associate professor of medicine and a cancer economist. will be presented during the conference. It is another practice-pattern study, this time looking at the expansion of DaVinci surgical robots and if they had an impact on treatment decisions for men diagnosed with prostate cancer.
Turns out, they have. We used data from the National Cancer Database to determine whether men chose surgery, radiation, or active surveillance. We then analyzed these treatment decisions based on the number of surgical robots that were present in their area when they made that decision. As more robots come to town, more people were electing surgery over radiation or active surveillance. We’re agnostic on whether this is a good idea or bad idea but found the data quite interesting.
Scott Eggener, MD, is a high-volume robotic and open surgeon who specializes in the care of patients with prostate, kidney and testicular cancer.