While I appreciate Dr. Attia’s broader commitment to prevention and patient education, I believe his position on prostate cancer screening overlooks some key clinical realities.
High-risk prostate cancers, such as Gleason 9, represent a minority—perhaps 10 to 15% of cases—and often arise de novo rather than progressing from indolent disease. That nuance is often lost in discussions about treatment/over-treatment.
I’ve also cared for patients with serious quality-of-life consequences following treatment, including a recent case where a patient required cystectomy due to radiation-associated bladder damage.
These are complex decisions that warrant shared decision-making, not blanket recommendations for PSA screening.
Thanks for your comment Daniel. As you mention, in Primary Care, we see a lot of side effects and quality of life issues after people undergo screening without really understanding downstream side effects. They buy into the rhetoric “we should catch cancer early.”
To your point that most aggressive cancers are de novo, I try to tell patients that often the paradox of cancer is “We won’t know if it will cause a problem, till after it has caused a problem.”
I agree.
While I appreciate Dr. Attia’s broader commitment to prevention and patient education, I believe his position on prostate cancer screening overlooks some key clinical realities.
High-risk prostate cancers, such as Gleason 9, represent a minority—perhaps 10 to 15% of cases—and often arise de novo rather than progressing from indolent disease. That nuance is often lost in discussions about treatment/over-treatment.
I’ve also cared for patients with serious quality-of-life consequences following treatment, including a recent case where a patient required cystectomy due to radiation-associated bladder damage.
These are complex decisions that warrant shared decision-making, not blanket recommendations for PSA screening.
Thanks for your comment Daniel. As you mention, in Primary Care, we see a lot of side effects and quality of life issues after people undergo screening without really understanding downstream side effects. They buy into the rhetoric “we should catch cancer early.”
To your point that most aggressive cancers are de novo, I try to tell patients that often the paradox of cancer is “We won’t know if it will cause a problem, till after it has caused a problem.”