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Local men will die if task force recommendations on prostate cancer screening are abided by



Published: Wed, May 30, 2012 @ 12:00 a.m.

Local men will die if task force recommendations on prostate cancer screening are abided by

On May 22, 2012, The Vindica- tor published a syndicated commentary written by Dr. Virginia A. Moyer that criticized routine screening for prostate cancer. Dr. Moyer, an academic pediatrician and chair of the U.S. Preventative Services Task Force, mentioned in her commentary that “screening men of any age for prostate cancer using the prostate specific antigen (PSA) blood test” is not recommended. She goes on to mention that “many men are harmed as a result of prostate cancer screening” and that screening is not recommended because only “one man in 1,000 screened will avoid death from prostate cancer.”

This logic is astounding to us as urologists caring for the people of the Mahoning Valley. We cannot feel more strongly that these recommendations will harm men in our area and feel compelled to rebut the claims of the USPSTF. The disease of prostate cancer is not the same from one man to another and thus making a claim that applies to all men is wrong. We do acknowledge that there are some forms of prostate cancer that do not require to be treated. However, in our work as doctors on a daily basis we, unfortunately, see men who were not diagnosed with prostate cancer in time and will therefore die from this disease. The academic and theoretical world is often much different than the practical world, and to generalize that this disease is nonleathal and does not need to be found early to the entire population is extremely irresponsible and dangerous of Dr. Moyer and the USPSTF.

Since the introduction of PSA in 1986 the overall death rate from prostate cancer has declined significantly — up to 40 percent in some studies. In short, early detection saves lives. Even if it were only one life in 1,000 as claimed by Dr. Moyer, that one life can be, and absolutely should be, saved very easily. The USPSTF report quotes studies and makes the assumption based on these studies that prostate cancer screening does not save lives. Many of the studies mentioned have innumerous flaws and the conclusions of these studies are based on bad science. One study was designed in 1990 and compared those who were screened and those who were not. However, the “unscreened” group was, in fact, truly screened and this contaminated and skewed the results making it appear that screening does not make a difference. Another study performed in Europe did show that screening for prostate cancer does save lives but the USPSTF did not include the update to this study in their recommendations. Thousands of articles have been written regarding the extremely complex and controversial subject matter of prostate cancer screening and treatment. Despite these studies, there still exist controversy. Until the time that this issue is definitively resolved and better tests become available, doctors should continue to utilize the current methods of screening for prostate cancer to allow for detection in the earliest possible stage.

Men at highest risk for prostate cancer are those men with a family history of prostate cancer, veterans who were exposed to Agent Orange in Vietnam, and African Americans. However, all men are at risk for developing prostate cancer within their lifetimes. In accordance with the American Urological Association guidelines, we recommend that all men discuss the pros and cons of prostate cancer screening with PSA with their physician and strongly urge these men to have an annual PSA and digital rectal examination beginning at the age of 40. This approach has saved many men’s lives in the Mahoning Valley. Without PSA and early detection of prostate cancer we will see more men who present to our offices who we can do very little to help.

Daniel Ricchiuti, M.D., Youngstown and 13 others.

Other signators to the letter are: Sudhir Baji, M.D.; Bradford Black, M.D.; John McElroy, M.D.; Mark Memo, D.O.; Richard Memo, M.D.; Paul Musselman, M.D.; Richard Nord, M.D.; Sunil Parulkar, M.D.; Robert Ricchiuti, M.D.; Vincent Ricchiuti, M.D.; Michael Scolieri, M.D.; Christopher Stiff, M.D., and James Stille, M.D.


Comments

1chuck_carney(499 comments)posted 1 year, 10 months ago

Is this a forerunner of things to come under Obama-care?

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2Rockyroad(149 comments)posted 1 year, 10 months ago

What a self-serving crock! I've been in the medical field for 36 years and the PSA had destroyed the quality of life for countless men. Of course the urologists would take issue with this as it is their bread and butter. "Oh, we found cancer cells, we have to remove the prostate and give you a life of misery...you can't make love and you'll have to wear a diaper...but we saved your life!" Baloney! Truth be told most men over 50 years old have cancer cells in their prostate. And guess what? If no overzealous doctor gets to them, those men will live a long, long time with all of their parts working for the duration. The docs who wrote that letter should be ashamed of themselves. They brainwash their patients, who trust them, into thinking that if they don't get treatment, they're going to die a horrible death. Then the patient justifies the decision to have treatment by feeling that their life has been saved, when nothing was going to happen. At best they save one in 1000, but that is no justification for performing such a life-altering surgery.
A gentleman in his late 60's was diagnosed with prostate cancer and urged to have the surgery to "save his life". His entire family was pressuring him to have the surgery, "Dad, you're going to die if you don't have surgery!" The man said, "If I can't make love to your mother ever again, life isn't worth living." He didn't have the surgery and he lived another 20 happy years.
The saying goes, if you ask a surgeon if you should have surgery, don't be surprised when he says, yes.
Live your life and don't get a PSA. It is a test that has done much more harm than good.

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3JBullfrog(21 comments)posted 1 year, 10 months ago

Rockyroad, my father is a patient of one of the doctors whose name is on this letter and they told him the same thing you said, that it is normal to have abnormal or cancer cells and he didn't have to worry since they were at such low levels. He didn't advocate surgery, in fact he counseled against it, and was very open and honest about what was going on and all the available options. Unless you know all the doctors who signed and the way they practice, please do not demonize them. While I'm sure there are some doctors who want to go directly to surgery, there are many who aren't. It is better to get tested so you can make the best decision for your health while there is still time to do so. That is what these doctors are advocating. Everyone has horror stories, but that does not mean we should make blanket statements about an entire field. If you have statistics about your claims I would be interested in seeing them. Also, I know several older men who have had their prostates removed and none of them have to wear diapers; they all seem to be doing fine with kegels. I don't know if this is normal or not, but from what I have seen it doesn't seem to be a problem.

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4Rockyroad(149 comments)posted 1 year, 10 months ago

Your father was the exception to the rule And unless you are one of the "older men" that you speak of, you have no idea what they are going through. PSA's cause more harm than any single test.

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5Rockyroad(149 comments)posted 1 year, 10 months ago

Lastly, Bullfrog, it has nothing to do with "knowing the doctors". It has to do with "the doctors" using scare tactics to frighten patients into getting a test that has no value but to bring the docs business. Your father got the PSA, it was high, so he went to see one of those docs. He was told that he had cancer cells, but now was not the time for action. But at some point, when he goes back for his many follow-ups, the bell will toll and the doc, who now has much credibility, will call for surgery, radiation and chemo. Until then your father and you can worry; needlessly. Your father will die of something else, not prostate cancer, without any treatment. But the quality of his life has been diminished by the PSA.
You are typical of most of the American populace who want to believe that if they can "catch" something early enough, they will live forever. I look at the poor souls at the Relay for Life being thankful their cancer was "caught in time". Yes, some are fortunate, but most are not because their cancer wasn't going to be life-threatening. But they don't believe that because they have been sold a bill of goods. They will to a person praise their doctors for catching it in time. All they "catch" for most of them is plenty of anxiety, needless treatment, poor quality of life and not one day more. Most times, if you have a condition, it is best that you and your doctor know nothing about it. Ignorance is bliss. Enjoy your life. Avoid tests. Avoid doctors and hospitals and more than likely you will live a long, happy life.

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6seagull173(5 comments)posted 1 year, 10 months ago

Check this website: http://www.prostatefoundation.org/loo...
Read all you can before subjecting yourself to a PSA test.

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7seagull173(5 comments)posted 1 year, 10 months ago

I had the PSA done over 11 years ago and had no idea what I was getting into, needless to say the results created a lot of stress for me. If you are any where near a 4.0 reading these urologists are ready to drill you. And after that you still will not really know your status, you go into their wheelhouse. The urologists just love to do biopsies, it's a money maker for them. If you have a family history you are pretty much on your own but if you don't have a family history then blow this test off.

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8dricchiuti(1 comment)posted 1 year, 10 months ago

Rockyroad, it would be unprofessional for me to enter into an argument with you over this subject. Obviously you and seagull173 represent the negative effects that PSA and prostate cancer treatment can have on men's lives. You make some very valid points. It is obvious that you have been mistreated by the very profession which you make your living through.

Please, however, do not generalize your experiences with those of all men. Please also do not assume that doctors prioritize monetary gain over the welfare of their patients or that our comments are self-serving. If you saw the ugly side of this disease as we do daily, I am certain that you would feel foolish for many of the things that you have said. Men do die from prostate cancer. We are not searching for the insignificant varieties of prostate cancer to treat but those aggressive forms that can be lethal if not treated.

As mentioned in our letter, not all forms of prostate cancer need to be treated. It is important that patients and their physician have a full understanding of all of the risks associated with prostate cancer screening and treatment. At the end of the day it is an individual decision on the part of the patient.

Daniel Ricchiuti, M.D.

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9seagull173(5 comments)posted 1 year, 10 months ago

Dr. Ricchiuti: "It is obvious that you have been mistreated by the very profession which you make your living through." YOUR profession, not mine. The "experts" have lined up for and against the PSA test and have left the lay people hanging. Dr. Ablin has convinced me about the usefulness of this test. But in the meantime your PSA test has created 11 years on anguish for me. Isn't it about time that YOUR profession has put the PSA test in the same status as blood letting.

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