Shuffle off to Buffalo for another questionable prostate screening promotion

By now, any health care consumer with a pulse knows about the tradeoffs involved in prostate cancer screening.  It must have reached most corners of the US that mass prostate cancer screening is not recommended by:

• the US Preventive Services Task Force
• the American College of Physicians: “Doctors should inform men aged 50 to 69 years about the limited potential benefits and substantial potential harms of prostate cancer screening. Patients and doctors should base screening decisions on the patient’s preferences, prostate cancer risk, health, and life expectancy. Doctors should not screen for prostate cancer using PSA unless patients express a clear preference for screening after discussion.”
• the American Cancer Society: “Prostate cancer screening should not occur without an informed decision-making process.”
• the American Academy of Family Physicians. 

Even the American Urological Association now states that:

• PSA screening in men under age 40 years is not recommended.
• Routine screening in men between ages 40 to 54 years at average risk is not recommended.
• For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients’ values and preferences.
• To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
• Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

That is not the message one gets from Roswell Park Cancer Institute in Buffalo, as seen in this Buffalo Bills football team announcement:

For the third consecutive year, Roswell Park Cancer Institute (RPCI) and the Buffalo Bills are hosting the Prostate Cancer Early Diagnosis Outreach Clinic, a free prostate cancer education and early detection event, encouraging men to learn their own statistics such as their prostate-specific antigen (PSA) level, family history or other factors that may raise their prostate cancer risk. RPCI doctors will be performing free screenings in the Paul Maguire Club at Ralph Wilson Stadium that will include prostate-specific antigen (PSA) blood tests and digital rectal exams (DRE) for eligible men. …

“This event drives home the idea that knowledge of your health is empowering,” says James Mohler, MD, Associate Director and Senior-Vice President for Translational Research and Chair of the Department of Urology at RPCI. “Knowing your statistics and risk factors and getting the recommended screenings help detect these cancers at their earliest stages, when patients have the most options available to them.” 

I added the highlight to the phrases “encouraging men to learn their own statistics such as their PSA level” and “getting the recommended screenings.” Which “recommended screenings?” The ones you must do in order to learn your PSA level?  The ones that aren’t recommended by the organizations I listed above?

The evidence-based guidelines of each of the organizations listed above never end up with a “recommended screening.”  They end up – at their most aggressive – with a call for informed decision making.

This isn’t splitting hairs. The words matter.  And this announcement encourages men to get recommended screenings.

I did note that the announcement says screening will be done “for eligible men.” It doesn’t explain what that means.  I guess you’d need to show up at the event in order to find out.  And once you show up, what is the quality of the fully informed, shared decision-making at an event that encourages “recommended screenings?” How balanced is the presentation of tradeoffs? Of potential benefits and harms?

The football team announcement also links to Roswell Park’s Know Your Statistics web page. Right off the top, that page states:

Did you know that 1 in 7 men will be diagnosed with prostate cancer at some point in their lifetime? With early detection, about 90 percent of these cancers will be cured.

To be truly accurate, balanced and complete, that page might have said something like:

Many men are more likely to die with prostate cancer than from prostate cancer.  In other words, not all prostate cancers are killers.  Many will never cause a man any harm.  Treating those cancers may produce more harm than good. That’s why many organizations call for a complete and balanced discussion of tradeoffs before a man considers prostate cancer screening. 

I have a problem with obsessive “Know Your Statistics” campaigns.  I’ve written about that before and noted how one article referred to the fascination with monitoring that produces “numbers-obsessed lab test junkies.”

But I’ve also written in the past about Roswell Park’s questionable prostate cancer screening promotions such as  “men … lured in by offers of prizes like hockey tickets IF they commit to discuss screening.”

Oh, well, they certainly knew how to break up our Pinktober discussions!

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