DR. MARC SIEGEL: Biden's prostate cancer diagnosis reveals dangerous flaw in screening guidelines

If determination is 1 happening that the COVID pandemic taught us, it was the deficiency of flexibility, nimbleness and the predominant inaccuracy oregon retired of datedness of superimposed guidelines. I indispensable confess that arsenic a practicing internist for galore years, I person ne'er strictly adhered to guidelines and simply utilized them to usher me. Medicine is and ever has been an creation to beryllium practiced connected an idiosyncratic basis.

One of the guidelines that has bothered maine the astir is the U.S. Preventive Services Task Force Guideline – successful usage since 2012 -- not to urge regular Prostate Specific Antigen usage successful prostate crab screening. And adjacent the American Urological Association doesn’t urge regular screening implicit the property of 70.  Studies person shown that usage of the PSA has fallen disconnected apt successful men implicit the property of 40 arsenic a effect of the USPSTF recommendation.  This is peculiarly disturbing considering that determination are implicit 300,000 caller cases of prostate cancer successful the U.S. diagnosed each year, with implicit 35,000 deaths, galore of which whitethorn beryllium preventable with earlier diagnosis. 

So it is disturbingly imaginable that erstwhile President Biden’s spokesperson is telling the information erstwhile helium says that he wasn’t screened for prostate crab successful implicit a decade prior to his existent diagnosis of assertive metastatic disease. Perhaps helium and his doctors were conscionable rigidly pursuing an outdated and ill-conceived guideline. But this revelation, if true, is conscionable arsenic disturbing arsenic if the Biden White House were hiding a timelier earlier diagnosis from the American public, conscionable arsenic they person seemingly hidden different wellness realities regarding the erstwhile president.

BIDEN'S 'LAST KNOWN' PROSTATE CANCER SCREENING WAS OVER A DECADE AGO, AS QUESTIONS MOUNT OVER DIAGNOSIS

Delay and guessing successful the acheronian is simply not however I, and galore different internists and urologists, signifier medicine. The PSA itself tells america erstwhile it trends upward, often erstwhile it increases implicit 4, that determination is thing going connected successful the prostate. The emergence whitethorn oregon whitethorn not beryllium owed to prostate cancer. When combined with a "free PSA," if low, the likelihood of prostate crab increases. We are besides connected the verge of familial investigating and liquid biopsies (blood tests) which volition summation the accuracy of prostate crab screening and we already person useful biomarker screening tests for prostate crab successful the urine. 

Luckily, contempt the information that existent screening guidelines are not up-to-date oregon useful, I tin inactive bid a PSA and person Medicare screen it for immoderate property if I accidental the trial is medically necessary.

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I request to cognize that information, combined with a integer rectal exam looking for nodules, to cognize what to bash adjacent careless of my patient’s age. If either trial is abnormal, I tin past take to proceed to an MRI of the prostate, which has go much close astatine looking for prostate crab arsenic the trial has evolved and advanced.  An MRI effect tin nonstop a urologist arsenic to whether a biopsy is indispensable and wherever successful the prostate to nonstop this biopsy.

If a diligent has prostate cancer, determination are galore attraction options available, depending connected the signifier and aggressivity. These treatments person besides precocious implicit the years and are amended tolerated with less broadside effects, which means they whitethorn beryllium tolerated by men of older ages and successful poorer health. If a cure is possible, past either robotic extremist prostatectomy oregon assorted forms of radiation treatments are considered. And if the prostate crab is metastatic, arsenic successful President Joe Biden’s case, hormone therapy to people testosterone (which whitethorn beryllium causing the tumor to grow), whitethorn beryllium utilized oregon combined with different treatments, including targeted therapies, immunotherapy, oregon chemotherapy. There are even studies which amusement that it whitethorn amended result to inactive region the prostate adjacent successful immoderate precocious cases. 

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Many critics are saying that a president of the United States should person the astir assertive prostate crab screening careless simply due to the fact that helium is president. But I americium saying that each men implicit the property of 45 should person this screening. Period. Regardless of age. 

Medical knowledge is powerfulness and what I bash with the accusation I get to assistance my diligent is the creation of medicine. Not knowing is ne'er the close answer.

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