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January 2015

PSA Screening—I Finally Won!

Author Affiliations
  • 1Department of Family Medicine, Georgetown University Medical Center, Washington, DC
JAMA Intern Med. 2015;175(1):16-17. doi:10.1001/jamainternmed.2014.5441

I must have won. That is what everyone tells me. At the beginning there were a few telephone calls, followed by e-mails, and now every talk I give someone brings up how happy I must feel for winning. What I purportedly won was the new recommendations against routine checking for prostate-specific antigen (PSA). The new recommendations acknowledge the limitations of PSA after years of heated debate. I had written an essay about our malpractice system and evidence-based medicine (EBM) after being sued, but the take-home point for many was that I did not order a PSA test after discussing the options with a patient. The new recommendations are consistent with how I practiced. I “won.”1

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    2 Comments for this article
    PSA testing could have saved your patient's life
    David L Keller, MD | Independent
    I have written extensively on PubMed Commons on why the USPSTF was wrong about PSA testing. Powerful observational data links PSA testing to a significant and robust drop in prostate cancer mortality in every society where it gains widespread use, including a drop of 40% in the US. The randomized trials were butchered by non-adherence to protocol: 52% of the PLCO controls received off-protocol PSA testing. From the Goteburg sub-study, we learned that the better the adherence to protocol (both active and control arms) the more strongly the data supports the life-saving potential of PSA screening. Each year of additional follow-up strengthens the benefits of PSA. In 10 years, the USPSTF will be forced to change their D to an A, and I hope you will write an editorial giving the USPSTF their proper credit in your patient's avoidable death from prostate cancer.
    Standard of care is usually a national issue
    Brett T Snodgrass, MD | DrSocial Ltd.

    The author of this article reports an unfortunate event of injustice that highlights the failings of our malpractice system.

    The attorney, in this case, should have cited the 1993 case of Mishler v. Nevada State Board of Medical Examiners. The issue of "standard of care" by locality was discussed and rejected. They established that physicians such as family medicine doctors are certified by a national organization, the ABMS. Therefore, the "standard of care" should be considered a national issue, and not a local one.

    Had the attorney referenced the Mishler case, the article's author may have
    won the first time. The court ruling can be found at http://drsocial.org/forums/topic/1131/mishler-v-arizona-medical-board/