An oncologist's take on the updated prostate cancer screening guidelines

The U.S. Preventive Services Task Force (the writers of the evidenced-based health screening Bible we affectionately called The Blue Book in residency, though I see it is no longer blue!) has come to a dramatic conclusion, no longer recommending screening for prostate cancer in asymptomatic men aged 75 years and older. Members of the task force have been commenting in the media about lead-time bias and the impact the treatments for prostate cancer have on quality of life as compelling forces behind the recommendation.

In all, I am happy about this because I believe we are over-screening for prostate cancer in older men, and many of the men who are diagnosed and treated go through unnecessary suffering and anxiety. Also, I find the task force to be a well-intentioned and scientifically sound group. I do worry about the validity of saying there is some magic age beyond which it would not be advisable to screen. A take on the old adage is true here: once you know someone who is 75, you know one person who is 75. There are unique circumstances for each patient which may or may not make screening advisable, which goes beyond just age. It's hard to put such a nuanced discussion into a coherent expert opinion though. (And that's why it's called the art of medicine).

Although I think many clinicians will support these recommendations, the reaction has not been universally positive. Just look at the comments left on The Wall Street Journal blog. (A small editorial comment, if I may: I find the association made by some commenters that this is a way of rationing precious health care resources and is ageist to be patently offensive. Also distasteful: the comment that this is a step towards socialized medicine. To me, this is a way of avoiding harm [reckoning back to the lessons of Primum Non Nocere from med school ...] to older men, rather than a way to shove them in a corner to wither and die. Those who know me know I would never advocate something like that. I'll get off the soapbox now.) What do you think about these recommendations? Do you think clinicians will follow them? Should they?