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Ideas and Opinions |

Is Prostate-Specific Antigen Screening “Proven Ineffective Care”?Is PSA Screening “Proven Ineffective Care”?

Michael J. Barry, MD; and Peter C. Albertsen, MD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 23 February 2016.


From Massachusetts General Hospital, Boston, Massachusetts, and University of Connecticut School of Medicine, Farmington, Connecticut.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3025.

Requests for Single Reprints: Michael J. Barry, MD, General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, Suite 802, Boston, MA 02114; e-mail, mbarry@mgh.harvard.edu.

Current Author Addresses: Dr. Barry: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, Suite 802, Boston, MA 02114.

Dr. Albertsen: Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955.

Author Contributions: Conception and design: M.J. Barry, P.C. Albertsen.

Drafting of the article: M.J. Barry, P.C. Albertsen.

Critical revision of the article for important intellectual content: P.C. Albertsen.

Final approval of the article: M.J. Barry, P.C. Albertsen.


Ann Intern Med. 2016;164(10):687-688. doi:10.7326/M15-3025
© 2016 American College of Physicians
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A recently proposed quality measure, “Non-Recommended PSA-Based Screening,” has generated considerable debate. It would be one of the first U.S. quality metrics to focus on the delivery of too much rather than too little care. The authors discuss their concerns about the proposed measure.

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PSA Screening: The fault dear Brutus lies within us...
Posted on May 17, 2016
Stephen B. Strum, MD, FACP
Medical Oncologist Specializing in Prostate Cancer
Conflict of Interest: None Declared
After 53 years in medicine, I have come to the conclusion that the practice of medicine is indeed a "practice" and that the admonition Primum Non Nocere has far deeper intent i.e. the level of medical practice falls prey to the bell-shaped curve and a significant percentage of what is done results in harm. The truth is that for many physicians the primary focus of patient outcome takes a backseat to physician income, be it in the form of economics or ego. In this context we miss the value of a key biologic expression: the early diagnosis of cancer, be it prostate cancer (PC) or any form of malignancy. When we miss this "event" we miss what should be a trigger point or alert to assess the patient for the many fuels that cancer uses and the pathology associated with them. So with a diagnosis of PC, we miss the associated bone loss that commonly occurs, and other associations such as kidney disease, lipid abnormalities, cardiovascular disease, cognitive dysfunction, etc. In other words, an earlier diagnosis of PC at any age should not result in a reflex response that often equates with invasive therapy, but an assessment of the patient for the many biologic expressions that part and parcel of a cancer diagnosis. I refer to this as SAIN (Systems Analysis & Integrity Networking) medicine, and it offers an opportunity to guide patients to improved quality and quantity of life. In many men, of any age, it may obviate the need for invasive procedures that are costly to the overall well-being of the patient. The fault, dear Brutus lies within us and our failure to see value of PSA testing in the context of truly caring for the patient. We are pinning the tail on the wrong donkey (the PSA test) rather than on those physicians who fall into the wrong part of the bell-shaped curve.
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