On the Urology Workforce, Targeted Screening,
And the US Preventive Services Task Force

It is abundantly clear that the US Preventive Services Task Force Draft Guidelines on Prostate Cancer Screening will not be welcome news to many urologists. I have attended numerous annual meetings of the American Urological Association, the physician organization for urologists. The majority of papers  concern that walnut-shaped gland, the prostate, usually taking up prostate cancer or an enlarged prostate, AKA BPH (benign prostatic hyperplasia). Some urology practices focus  exclusively on the prostate. Urologists will need to readjust.

As one doctor who has nothing to do with the US Preventive Services Task Force told me: “There is plenty of honest urology for them to practice….stones, incontinence, kidney cancer etc. But even in the world of prostate cancer a good 20% to 30% of patients have bad enough disease that they deserve attention and, perhaps, more of it than they have been given in the past due to the crazed gold rush towards the low-risk men.” I agree totally with this statement. If Americans could vote with their feet, I think too that they would want urologists to treat the truly important areas in urology, rather than a disease that the odds are will not cause trouble for most men.

Jeez, it would be welcome news if the public understood this and if it was talked about more openly. As a reporter, I have witnessed the fleeing of docs from real medicine to cosmetic surgery and the rich. How refreshing it would be if urology began to turn out more doctors that patients need.

On another note, the Draft Recommendations that will be released officially tomorrow are expected to address concerns of high-risk individuals. The word is out that there will be a call for research into whether or not there should be targeted screening. In other words, should high-risk men (e.g. because of family history) be screened, and at what intervals? That should come as some comfort to people who worry that the high risk will be lumped into one healthy asymptomatic category.

The comment period begins after the official release tomorrow. If you have thoughts about the draft recommendations, positive or negative, get them on the public record. There’s plenty that patients and the public  will want to mull over. Ask questions and don’t leave it to someone else.  I’ll be following this issue, providing follow-up links on where to send your comments, and more.

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6 Responses to On the Urology Workforce, Targeted Screening,
And the US Preventive Services Task Force

  1. ebbolles says:

    Excellent post, lively and informed.

  2. EllenTK says:

    Thanks for your take on this, Laura. Always helpful.

  3. Barbara Ravage says:

    I’ve just listened to disjointed bits on the Dianne Rehm show (in car doing errands). Shannon Brownlee was on, also some pretty pissed-off urologists, and since Dianne is on vacation, her sub, Steve Roberts, did a less skillful job that she would have, in my opinion. All those worried men! Some worried about their bottom line, others worried about, well, you know. And I could see Roberts’ furrowed brow coming through his voice. I kept thinking, jeez, we women have had lousy birth control options; menopausal nightmares and medical fixes that ended up biting back; the imperfect and highly uncomfortable mammogram, with shifting recommendations on when and how often; and osteoporosis screening that is beyond flawed and medications with significant adverse effects, but I don’t recall quite this amount of hand-wringing. Man up, guys!

    • Laura Newman says:

      This is really loaded for men and people are only just beginning to talk about tabooed topics, like impotence, incontinence, whether or not cancer is ever going to be of significance. It’s loaded. It may be hard to man up for some urologists whose entire practices are devoted to the prostate, but I reiterate that we ought to be talking a heck of a lot more about “honest urology” and other areas in medicine. There are pressing needs for sick people that are not being met with the pipeline of docs that we are turning out.

  4. Many Thanks for this, Laura,
    There are also some good letters in the NY Times today (10/11/11) in response to the latest research and comments are mixed, as expected. While I do not begin to know the answer to this complex issue, I’m eager to learn more in support of my husband who has a family history.

    • Laura Newman says:

      Good point, Kristin. When you mentioned that your husband has a family history, it occurred to me that implicit in the Draft Screening Recommendations is this: a large proportion of “prostate cancer” that is treated is cancer that was headed nowhere. We need a lot better information on “family history.” I know that once you’ve been treated for something, you automatically think that, of course, the treatment was essential. That said, there are certainly bad prostate cancers. I am trying to think this through for another post. Wishing him the best of health.

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