November 18, 2011
Commentary by Robert Pugach, MD
Stop PSA Testing? What a Travesty

I’m writing this personally so that I can express my feelings about the recent recommendation from the United States Preventive Services Task Force (USPSTF) that PSA screening for prostate cancer should be stopped.  I want to publicly state, along with thousands of urologists across our country, that this advice from the USPSTF should be condemned for what it is – an attempt to save dollars at the expense of the lives of our patients. 

This is the same group that recommended that women should start mammogram screening for breast cancer 5 years later than has been done in the past.  Women’s groups were up in arms about this policy which was promulgated just to save money rather than to protect the health of women in the fight against breast cancer.  Would anyone argue that we have made amazing advances against breast cancer because of mammography screening?  That’s why the USPSTF’s recommendations to delay screening were criticized, ridiculed and tossed aside by women’s rights groups and leading cancer prevention organizations like the American Cancer Society.

After the USPSTF attacked prostate cancer screening, they followed that with a policy that said that screening for colon cancer and cervical cancer should be less frequent than it is now. 

What is going on here?  The USPSTF is literally doing financial calculations to see how much it costs to save one life in the battle against cancer.  Since when do we put dollars ahead of the health of patients?  Since when do bureaucrats dictate that our health is less important than the money we spend to protect it?  Is this the future of healthcare in the United States?

I have devoted a large part of my medical career to diagnose prostate cancer at the earliest possible stage so that my patients can have their cancer cured with a minimal effect on their normal lives.  That’s the rationale for minimally invasive therapy to which I and the staff of Pacific Coast Urology Medical Center are dedicated.  Many of you reading this can attest to the benefits of that philosophy – early detection allows you to be cancer free with almost no change in your daily lifestyle. 

The USPSTF proposes to change all of that.  What a travesty that will be!  We should stand up and protest their inappropriate recommendations just as women did earlier this year when the revised mammogram recommendations were promulgated.  Let’s tell the USPSTF and our senators and representatives why we object to this and let our voices be heard in our democracy! 

I see many patients diagnosed at a late stage where all that I can offer is palliative care for the severe pain that widespread, metastatic prostate cancer causes.  A urologist in Phoenix, Arizona said it well: “I can personally attest to another and perhaps even more important factor that is being overlooked – suffering from advanced prostate cancer.”  Dr. Murray Feldstein said what I have observed during the 26 years I have been screening patients for prostate cancer: “No longer do I see patients with bulky cancer who bleed and obstruct their urinary tracts, many of whom required emergency procedures and were left with permanent indwelling catheters.  In addition, patients presenting with painful osseous [bone] metastases are now rare.”  The complications of these conditions, and the excruciating pain they suffered, are rare due to PSA testing.    

Carl Olsson, a leading urologist, the former chairman of the urology department at Columbia University and the physician in charge of the largest urology practice in the United States, recently stated: “I think the concept of having us give up on the identification of people who have prostate cancer, as well as on their treatment, is a backward step, to say the least.”
I take time from my practice every 2 years to attend a meeting at Harvard University where we focus on advances in prostate cancer treatment. The course director, Dr. Phillip Kantoff recently said “This is the wrong message at this point in time.”  Why did he say that?  Because he echoes what thousands of urologists like me do every day of our lives - trying to diagnose prostate cancer at an early stage so we can offer curative treatments for this vicious disease.  That’s why the death rate from prostate cancer has steadily declined over the past 10 years.  The USPSTF will reverse that trend.

To help fight this battle against inappropriate bureaucratic regulation of your healthcare I urge you to send a letter to send to your elected representatives.  You can send a template letter from the AACU.  Together, we can stop this madness and continue the fight against prostate cancer.  If you have any questions, please feel free to contact our office. Join the dialogue on our Facebook page.

Sincerely,

Robert G. Pugach, MD 

To read Forbes Magazine article, "The Department of Health and Human Services' Death Panel," November 21, 2011