— F.B. A: I remember that time very well.
The change does not have to do with insurance companies, but through a better understanding of how best to manage low-risk prostate cancer. Most prostate cancer found at screening (meaning men with no symptoms) is low-risk. Many times, both men and their physicians insisted on definitive treatment for even low-risk prostate cancer when it was found through screening.
That meant many men getting surgery, with its attendant high risks of sexual dysfunction and urinary incontinence, as well as a small risk of life-threatening complications. A review of the risks and benefits for prostate cancer screening as a whole found that the risks (including the many men who got complications) outweighed the benefits, and some (but not all) experts recommended against prostate cancer screening. While this prevented many complications from surgery, it also had the effect of preventing many men from being screened and, therefore, coming to medical attention only when the prostate cancer was advanced and no longer curable.
We weren't harming the low-risk men, but we weren't helping the high-risk men either. The current recommendation attempts to maximize the beneficial effects of screening while minimizing the harmful outcomes of performing surgery in men in whom it is not really necessary. Currently, men are recommended for a screening through a PSA test.
If this is abnormal, a careful evaluation often includes an imaging study of the prostate (such.
