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Letters To The Editor
Prostate Screening

The United States Preventive Services Task Force (USPSTF), a U.S. government supported organization, recently finalized its recommendation to discontinue PSA-based screening for prostate cancer for all men. We feel this was a recommendation that failed to recognize several important facts about prostate cancer, and that dealing with it in a “one size fits all” manner will ultimately lead to more American men dying from prostate cancer.

Data from Medicare itself shows that from 1993 to 2007 (when PSA screening became routinely used), deaths from prostate cancer decreased by 40% and patients presenting at diagnosis with metastatic disease (cancer spread beyond the prostate gland) decreased by 75%. It should also be noted that the Task Force based much of its decision on a seriously flawed study while it ignored two other large randomized trials that did show a significant benefit to PSA screening. Even with current screening rates, over 30,000 men will still die of prostate cancer in the United States this year and that number will undoubtedly increase in the future if we blindly follow this recommendation.

As clinicians who see prostate cancer patients everyday, we recognize that not all prostate cancer is the same. Prostate cancer can present with different levels of aggressiveness classified as low, intermediate, and high risk prostate cancer. Low risk disease can take 10 or more years to spread beyond the prostate while high risk disease can spread and ultimately kill in just a few years. If we abandon all screening, we will cheat men with the more aggressive forms of prostate cancer and those with a longer life expectancy (> 10 years) out of the chance for cure. As a result, more men will have to face the ravages of metastatic prostate cancer (i.e. bone pain and fracture, bleeding, urinary obstruction) and ultimate death from this disease.

As physicians, we recognize the value of evidence based medicine. But we also know the limitations of that data and we must combine our pooled clinical experience and expertise to individualize treatment decisions to optimize the health of our patients. A sweeping “one size fits all” decree such as the one suggested simply won’t do. Blindly following the USPSTF recommendation will result in more suffering and more needless deaths. Let’s not go back to the bad old days, let’s keep moving forward for the good of our grandfathers, fathers, brothers and sons!


R. Alex Hsi, MD
Peninsula Prostate Institute
Peninsula Cancer Center

Carleen Bensen, MD
Olympic Medical Physicians Urology Clinic
Peninsula Prostate Institute

Scott Bildsten, DO
Kitsap Urology Associates
Peninsula Prostate Institute

R. Heath Foxlee, MD
Peninsula Cancer Center
Peninsula Prostate Institute

Alan Kowitz, MD
Olympic Medical Physicians Specialty Clinic Sequim
Peninsula Prostate Institute

Berit Madsen, MD
Peninsula Cancer Center
Peninsula Prostate Institute

Marc Mitchell, DO
The Doctors Clinic
Peninsula Prostate Institute

Randall Moeller, MD
The Doctors Clinic
Peninsula Prostate Institute

Keith Schulze, MD
Kitsap Urology Asssociates
Peninsula Prostate Institute

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