To screen or not to screen for prostate cancer, that is the question. Or is it?

A report from the venerable United States Preventive Services Task Force (USPSTF) made it to the media yesterday--a bit ahead of schedule--and it not only says we aren't certain whether a man should get a PSA test to find prostate cancer early, it came flat out and said, effectively, "Don't do it!"

Now that is a recommendation that is going to create a good deal of discussion, I would think. More...

I wasn't going to write this blog.   But after listening to some of the reports on the news yesterday (while I was trying to stay healthy on my elliptical) I realized I had to say something, if for no other reason that to provide some context on an interesting and important piece of clinical research.

This week's Journal of the American Medical Association has a report indicating that many women no longer need to have the lymph nodes under their arm removed during breast cancer surgery-even if cancer is found in the single "sentinel lymph node" frequently removed as part of the surgical procedure.

This is one more piece of the puzzle that has been answered by clinical researchers and patients over decades, namely whether or not women diagnosed with breast cancer had to undergo radical disfiguring surgery to control their disease.

Now, this research shows that even less surgery is "more" when it comes to benefitting the patient.

The real question (which is the practical and important question) is whether doctors are going to listen to what the research tells them.  My concern-unfortunately-is that there are those docs who are simply going to ignore this report, and continue to go on doing what they have already done.  We want to believe that evidence guides medical practice, and in some places it does.  But in far too many institutions in this country "What I think" outweighs "what they know." More...

In early June I appeared on a nationwide news show and in a very brief comment indicated that I thought a new approach to radiation therapy in the treatment of primary breast cancer was "not ready for prime time."  Subsequently, later in the month, I wrote a blog on the treatment-called TARGIT-where I further outlined my concerns.  My primary issue-among some other more technical matters--were that the results of the trial were being promoted to suggest that the treatment was "ready" for moving into clinical use.  I wasn't so certain.

During this period of time, I was contacted by someone affiliated with the company that manufacturers the machine used to deliver the radiation, and offered an opportunity to have a discussion with some of the researchers involved in the clinical trials of TARGIT.  We accepted their offer.

Last week we had our follow-up call, and I think now is a good time to offer some information regarding that discussion.

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It all started typically enough a couple of weeks ago, with a request to review and comment on a study presented at the recent cancer meetings involving a new radiation therapy technique for the treatment of early stage breast cancer.

My comments-which were broadcast on a widely watched network evening news program-were reasonably straightforward: the study was interesting, but the treatment wasn't ready for widespread use until more information and longer follow-up was available.

Shortly afterwards, I got a phone call from someone representing the company concerned about my statements and offering further information about the study.  Now, I find myself trying to figure out how to sort through the research results and match what I have learned to what I think is the premature promotion of a potentially valuable new technique in the treatment of breast cancer for some women.

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