Latest news with #USPSTF
Medscape
23-05-2025
- Health
- Medscape
Save the USPSTF
Hi, everyone. I'm Dr Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor . Imagine arriving at the office at the start of a full day, only to discover that someone has taken away your stethoscope, you no longer have access to your electronic health record or online clinical references, your medical assistant was terminated overnight without your consent, and your patients can no longer hear you. Welcome to the real-life nightmare that the US Preventive Services Task Force (USPSTF) is facing. Earlier this year, the Trump administration fired about half of the employees at the Agency for Healthcare Research and Quality (AHRQ) and planned a restructuring of the Department of Health and Human Services (HHS) that would eliminate the agency and fold it into a new Office of Strategy. In April, 45 former Task Force chairs, members, and scientific directors sent an extraordinary letter to the Secretary of HHS, Robert F. Kennedy, Jr, warning that these actions would effectively bring the USPSTF's work to a halt. A few weeks later, former USPSTF chair Alex Krist, MD, MPH, and colleagues echoed this message in a JAMA viewpoint. Although primary care clinicians use the USPSTF's preventive care recommendations every day, most are unaware of the extensive supporting cast that makes the development of these recommendations possible. Since the 1990s, Congress has tasked AHRQ with convening the USPSTF, protecting its scientific independence, providing personnel and funding to maintain and update more than 140 recommendations on 90 clinical topics, and supporting its communications with medical organizations and the public. I can testify from personal experience that all these functions are essential to creating and disseminating evidence-based guidelines for primary care; as a young family physician working at the AHRQ, I staffed the USPSTF from 2006 to 2010. The uncertain future of AHRQ is not the only threat to the Task Force's continued existence. Many physicians do not realize that the Patient Protection and Affordable Care Act (ACA) provision that mandates no-cost coverage of the USPSTF's recommended services is currently at risk. On April 21, 2025, the Supreme Court heard arguments regarding the appeal of a 2022 lawsuit against the federal government by plaintiffs who objected, for religious reasons, to paying for medications for HIV preexposure prophylaxis. The plaintiffs asserted that the ACA's mandate requiring insurers to cover preventive services with A or B grades is unconstitutional because USPSTF members are not nominated by the President or confirmed by the Senate; traditionally, members have been selected by the AHRQ Director and approved by the HHS Secretary. The preventive services at risk of losing coverage include, but are not limited to, screenings for breast cancer, colorectal cancer, perinatal depression, cervical cancer, intimate partner violence, lung cancer, HIV, and hepatitis B and C. This ruling would also affect no-cost coverage for medications to reduce breast cancer risk and statin use to prevent cardiovascular disease. Although the legal issues are arcane and complex, a ruling against the government could dissolve the USPSTF and jeopardize care for millions of Americans. A recent study found that 1 in 3 persons and nearly half of women received no-cost preventive services between 2018 to 2022 as a result of the ACA mandate. Researchers also conducted a modeling study to simulate the potential impact of this court ruling, and they found that losing access to no-cost colorectal cancer screenings could increase colorectal cancer incidence by 5.1% and colorectal cancer mortality by 9.1%. Furthermore, decreased screening participation could also lead to increased long-term health care costs, given increased cancer incidence and more intensive care requirements due to delayed diagnoses. The USPSTF's judgments are not perfect. On occasion, I have disagreed with its assessments, and I suspect that most family physicians have questioned a new or updated recommendation now and then. But it is clear that if the AHRQ is eliminated and its functions are not replaced, or if the Supreme Court strikes down the ACA's mandate and Congress does not act to preserve the USPSTF, we cannot ensure that evidence-based preventive care will remain affordable for everyone. In sum, our patients will suffer. Many physicians and health care professionals have shied away from engaging in policy debates regarding the size and structure of government in general and health agencies in particular. But when is it time to speak up? Dr Steven Woolf, a family physician and former USPSTF member, recently argued, 'To condone policies that the [medical] profession knows will compromise health — or to remain silent and look away — is to be complicit in putting population health at risk,' and 'We must draw the line when the science is clear that a policy will increase the risk of disease, complications, or premature death.' This is that time. I encourage you to contact your Congressional representatives to express your support for this vital organization and check if your state has enacted legislation to adopt the ACA's preventive services mandate into their state insurance code. Your voice matters. By advocating for the USPSTF, you are helping to protect health recommendations that benefit all Americans. Together, we can ensure that the work of the USPSTF continues to thrive and serve the health needs of our patients and communities.
Yahoo
22-05-2025
- Health
- Yahoo
Given Biden's diagnosis, what a urologist wants you to know about prostate screening
EDITOR'S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine. When I learned that former President Joe Biden had not undergone prostate-specific antigen (PSA) screening since 2014—and was later diagnosed with metastatic prostate cancer—I knew there would be renewed interest and debate about prostate cancer screening guidelines. As a urologist, I regularly discuss the complexities surrounding PSA testing with my patients. The PSA test remains valuable for early detection, but it continues to generate controversy due to its limitations. Here's what you should know about PSA screening, why medical guidelines vary and why individualized approaches are essential. Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. Typically, a PSA level above 4 on lab results is flagged as 'abnormal,' prompting further evaluation. However, even PSA numbers below 4 can be concerning if they're rapidly increasing. That's why PSA tests are done annually: to monitor trends over time. Elevated PSA levels don't always mean cancer. Noncancerous conditions like an enlarged prostate, prostatitis (inflammation), recent ejaculation, stress or even strenuous activity can temporarily raise PSA. Ultimately, the PSA level is just a starting point for a deeper investigation (or conversation). Additionally, not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor. The controversy around PSA testing isn't really about the test itself, but about how its results are interpreted and acted upon. Before 2012, PSA screening was routinely recommended for all men over age 50. I completed my urology training that same year, witnessing firsthand how dramatically the screening landscape changed almost overnight. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening due to concerns of 'overdiagnosis.' The worry was that screening could detect slow-growing cancers that may never cause harm but still result in unnecessary biopsies, anxiety, and treatments—some of which caused more harm than good. The recommendation led doctors to scale back, causing routine PSA testing to decline sharply. However, by 2018, new research and rising concerns about aggressive prostate cancers led the USPSTF to revise their recommendations again, advising men aged 55 to 69 to engage in shared decision-making with their providers. This current stance emphasizes personalized discussions between patients and doctors, acknowledging that there's no one-size-fits-all approach to PSA testing. According to their website, the USPSTF is now working on another update, so we can expect further adjustments in the near future. As someone who experienced this shift firsthand early in my career, I deeply appreciate how critical shared decision-making and patient involvement are in navigating these complex screening choices. These ongoing changes in recommendations have also reinforced the importance for me as a physician to stay informed, continuously adapting my practice as new research and technologies emerge. Several organizations provide prostate cancer screening guidelines, including the USPSTF, the American Cancer Society and the American Urological Association (AUA). Each offers slightly different recommendations for both patients and health care providers. The USPSTF generally focuses on minimizing potential harm from overtreatment, while the AUA provides detailed, individualized recommendations based on clinical factors and risk profiles. Even after practicing urology for more than a decade, I still sometimes find it challenging to navigate these subtle differences in guidelines. Although I primarily follow the AUA guidelines—my overarching professional body—I've established a balanced approach that feels comfortable for me and, I believe, best serves my patients' interests. I start PSA testing at age 40 for men at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer. For most patients, I typically initiate annual PSA screening at age 50. It's important to know that primary care doctors perform most prostate cancer screenings. Depending on their training, clinical judgment and professional guidelines, their approach may differ slightly from my take as a urologist. This highlights the importance of clear communication among you the patient, your primary care provider and your specialists. Only through these conversations can we create personalized screening strategies that align with your health goals. President Biden's case raises a question: Could earlier PSA screening have detected his cancer sooner, at a more treatable stage? We will never know for certain. According to current guidelines, stopping screening in one's 70s is considered appropriate. Perhaps there was a shared decision to stop testing. From a guideline perspective, nothing was necessarily done incorrectly. Still, Biden's diagnosis highlights the potential consequences of discontinuing prostate screening for an otherwise healthy older adult. Men in the United States now have an average life expectancy of approximately 76 years, with many living healthy, active lives well into their 80s and beyond. Older guidelines based on shorter lifespans now need updating to reflect today's longer, healthier lives. I believe that decisions about prostate screening in older adults should thus focus more on individual health status rather than chronological age alone. Changing guidelines based on longer life expectancy will require thorough research and evidence-based data. Consequently, updates to recommendations will take time. What you can do in the meantime is be proactive in your conversations with your doctors about not just prostate cancer screenings but all cancer screenings. Prostate cancer isn't the only medical condition subject to evolving guidelines. Screening recommendations for colorectal and breast cancers have also changed recently. Colon cancer screening now generally starts at age 45 instead of 50 due to rising cases among younger adults. Breast cancer guidelines continue to vary among organizations, but the USPSTF updated its recommendation last year to say that most women should start getting mammograms earlier. These frequent shifts reflect ongoing research and the importance of personalized, informed conversations between patients and health care providers. Historically, an elevated PSA test led directly to a prostate biopsy, potentially causing unnecessary anxiety and sometimes overtreatment. Today, however, we have more advanced PSA-based tests that help better identify significant prostate cancers. Advanced imaging, like prostate MRI, allows us to pinpoint suspicious areas before performing a biopsy, increasing accuracy and decreasing unnecessary procedures. Biopsy techniques have also improved, some shifting from traditional transrectal biopsies to transperineal methods, reducing infection risks. Treatments have similarly evolved, emphasizing active surveillance of low-risk cancers and minimally invasive focal therapies. These advancements have significantly reduced side effects and improved quality of life, even among older patients. In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together. If your doctor hasn't initiated this conversation yet, it's important for you to bring it up. And remember, regardless of age, promptly inform your health care provider about any new urinary symptoms or health concerns. Staying proactive gives you the best chance to maintain good health this year and next.
CNN
22-05-2025
- Health
- CNN
What a urologist wants you to know about prostate screening
Cancer Men's health Joe BidenFacebookTweetLink Follow EDITOR'S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine. When I learned that former President Joe Biden had not undergone prostate-specific antigen (PSA) screening since 2014—and was later diagnosed with metastatic prostate cancer—I knew there would be renewed interest and debate about prostate cancer screening guidelines. As a urologist, I regularly discuss the complexities surrounding PSA testing with my patients. The PSA test remains valuable for early detection, but it continues to generate controversy due to its limitations. Here's what you should know about PSA screening, why medical guidelines vary and why individualized approaches are essential. Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. Typically, a PSA level above 4 on lab results is flagged as 'abnormal,' prompting further evaluation. However, even PSA numbers below 4 can be concerning if they're rapidly increasing. That's why PSA tests are done annually: to monitor trends over time. Elevated PSA levels don't always mean cancer. Noncancerous conditions like an enlarged prostate, prostatitis (inflammation), recent ejaculation, stress or even strenuous activity can temporarily raise PSA. Ultimately, the PSA level is just a starting point for a deeper investigation (or conversation). Additionally, not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor. The controversy around PSA testing isn't really about the test itself, but about how its results are interpreted and acted upon. Before 2012, PSA screening was routinely recommended for all men over age 50. I completed my urology training that same year, witnessing firsthand how dramatically the screening landscape changed almost overnight. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening due to concerns of 'overdiagnosis.' The worry was that screening could detect slow-growing cancers that may never cause harm but still result in unnecessary biopsies, anxiety, and treatments—some of which caused more harm than good. The recommendation led doctors to scale back, causing routine PSA testing to decline sharply. However, by 2018, new research and rising concerns about aggressive prostate cancers led the USPSTF to revise their recommendations again, advising men aged 55 to 69 to engage in shared decision-making with their providers. This current stance emphasizes personalized discussions between patients and doctors, acknowledging that there's no one-size-fits-all approach to PSA testing. According to their website, the USPSTF is now working on another update, so we can expect further adjustments in the near future. As someone who experienced this shift firsthand early in my career, I deeply appreciate how critical shared decision-making and patient involvement are in navigating these complex screening choices. These ongoing changes in recommendations have also reinforced the importance for me as a physician to stay informed, continuously adapting my practice as new research and technologies emerge. Several organizations provide prostate cancer screening guidelines, including the USPSTF, the American Cancer Society and the American Urological Association (AUA). Each offers slightly different recommendations for both patients and health care providers. The USPSTF generally focuses on minimizing potential harm from overtreatment, while the AUA provides detailed, individualized recommendations based on clinical factors and risk profiles. Even after practicing urology for more than a decade, I still sometimes find it challenging to navigate these subtle differences in guidelines. Although I primarily follow the AUA guidelines—my overarching professional body—I've established a balanced approach that feels comfortable for me and, I believe, best serves my patients' interests. I start PSA testing at age 40 for men at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer. For most patients, I typically initiate annual PSA screening at age 50. It's important to know that primary care doctors perform most prostate cancer screenings. Depending on their training, clinical judgment and professional guidelines, their approach may differ slightly from my take as a urologist. This highlights the importance of clear communication among you the patient, your primary care provider and your specialists. Only through these conversations can we create personalized screening strategies that align with your health goals. President Biden's case raises a question: Could earlier PSA screening have detected his cancer sooner, at a more treatable stage? We will never know for certain. According to current guidelines, stopping screening in one's 70s is considered appropriate. Perhaps there was a shared decision to stop testing. From a guideline perspective, nothing was necessarily done incorrectly. Still, Biden's diagnosis highlights the potential consequences of discontinuing prostate screening for an otherwise healthy older adult. Men in the United States now have an average life expectancy of approximately 76 years, with many living healthy, active lives well into their 80s and beyond. Older guidelines based on shorter lifespans now need updating to reflect today's longer, healthier lives. I believe that decisions about prostate screening in older adults should thus focus more on individual health status rather than chronological age alone. Changing guidelines based on longer life expectancy will require thorough research and evidence-based data. Consequently, updates to recommendations will take time. What you can do in the meantime is be proactive in your conversations with your doctors about not just prostate cancer screenings but all cancer screenings. Prostate cancer isn't the only medical condition subject to evolving guidelines. Screening recommendations for colorectal and breast cancers have also changed recently. Colon cancer screening now generally starts at age 45 instead of 50 due to rising cases among younger adults. Breast cancer guidelines continue to vary among organizations, but the USPSTF updated its recommendation last year to say that most women should start getting mammograms earlier. These frequent shifts reflect ongoing research and the importance of personalized, informed conversations between patients and health care providers. Historically, an elevated PSA test led directly to a prostate biopsy, potentially causing unnecessary anxiety and sometimes overtreatment. Today, however, we have more advanced PSA-based tests that help better identify significant prostate cancers. Advanced imaging, like prostate MRI, allows us to pinpoint suspicious areas before performing a biopsy, increasing accuracy and decreasing unnecessary procedures. Biopsy techniques have also improved, some shifting from traditional transrectal biopsies to transperineal methods, reducing infection risks. Treatments have similarly evolved, emphasizing active surveillance of low-risk cancers and minimally invasive focal therapies. These advancements have significantly reduced side effects and improved quality of life, even among older patients. In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together. If your doctor hasn't initiated this conversation yet, it's important for you to bring it up. And remember, regardless of age, promptly inform your health care provider about any new urinary symptoms or health concerns. Staying proactive gives you the best chance to maintain good health this year and next.
CNN
22-05-2025
- Health
- CNN
What a urologist wants you to know about prostate screening
EDITOR'S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine. When I learned that former President Joe Biden had not undergone prostate-specific antigen (PSA) screening since 2014—and was later diagnosed with metastatic prostate cancer—I knew there would be renewed interest and debate about prostate cancer screening guidelines. As a urologist, I regularly discuss the complexities surrounding PSA testing with my patients. The PSA test remains valuable for early detection, but it continues to generate controversy due to its limitations. Here's what you should know about PSA screening, why medical guidelines vary and why individualized approaches are essential. Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. Typically, a PSA level above 4 on lab results is flagged as 'abnormal,' prompting further evaluation. However, even PSA numbers below 4 can be concerning if they're rapidly increasing. That's why PSA tests are done annually: to monitor trends over time. Elevated PSA levels don't always mean cancer. Noncancerous conditions like an enlarged prostate, prostatitis (inflammation), recent ejaculation, stress or even strenuous activity can temporarily raise PSA. Ultimately, the PSA level is just a starting point for a deeper investigation (or conversation). Additionally, not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor. The controversy around PSA testing isn't really about the test itself, but about how its results are interpreted and acted upon. Before 2012, PSA screening was routinely recommended for all men over age 50. I completed my urology training that same year, witnessing firsthand how dramatically the screening landscape changed almost overnight. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening due to concerns of 'overdiagnosis.' The worry was that screening could detect slow-growing cancers that may never cause harm but still result in unnecessary biopsies, anxiety, and treatments—some of which caused more harm than good. The recommendation led doctors to scale back, causing routine PSA testing to decline sharply. However, by 2018, new research and rising concerns about aggressive prostate cancers led the USPSTF to revise their recommendations again, advising men aged 55 to 69 to engage in shared decision-making with their providers. This current stance emphasizes personalized discussions between patients and doctors, acknowledging that there's no one-size-fits-all approach to PSA testing. According to their website, the USPSTF is now working on another update, so we can expect further adjustments in the near future. As someone who experienced this shift firsthand early in my career, I deeply appreciate how critical shared decision-making and patient involvement are in navigating these complex screening choices. These ongoing changes in recommendations have also reinforced the importance for me as a physician to stay informed, continuously adapting my practice as new research and technologies emerge. Several organizations provide prostate cancer screening guidelines, including the USPSTF, the American Cancer Society and the American Urological Association (AUA). Each offers slightly different recommendations for both patients and health care providers. The USPSTF generally focuses on minimizing potential harm from overtreatment, while the AUA provides detailed, individualized recommendations based on clinical factors and risk profiles. Even after practicing urology for more than a decade, I still sometimes find it challenging to navigate these subtle differences in guidelines. Although I primarily follow the AUA guidelines—my overarching professional body—I've established a balanced approach that feels comfortable for me and, I believe, best serves my patients' interests. I start PSA testing at age 40 for men at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer. For most patients, I typically initiate annual PSA screening at age 50. It's important to know that primary care doctors perform most prostate cancer screenings. Depending on their training, clinical judgment and professional guidelines, their approach may differ slightly from my take as a urologist. This highlights the importance of clear communication among you the patient, your primary care provider and your specialists. Only through these conversations can we create personalized screening strategies that align with your health goals. President Biden's case raises a question: Could earlier PSA screening have detected his cancer sooner, at a more treatable stage? We will never know for certain. According to current guidelines, stopping screening in one's 70s is considered appropriate. Perhaps there was a shared decision to stop testing. From a guideline perspective, nothing was necessarily done incorrectly. Still, Biden's diagnosis highlights the potential consequences of discontinuing prostate screening for an otherwise healthy older adult. Men in the United States now have an average life expectancy of approximately 76 years, with many living healthy, active lives well into their 80s and beyond. Older guidelines based on shorter lifespans now need updating to reflect today's longer, healthier lives. I believe that decisions about prostate screening in older adults should thus focus more on individual health status rather than chronological age alone. Changing guidelines based on longer life expectancy will require thorough research and evidence-based data. Consequently, updates to recommendations will take time. What you can do in the meantime is be proactive in your conversations with your doctors about not just prostate cancer screenings but all cancer screenings. Prostate cancer isn't the only medical condition subject to evolving guidelines. Screening recommendations for colorectal and breast cancers have also changed recently. Colon cancer screening now generally starts at age 45 instead of 50 due to rising cases among younger adults. Breast cancer guidelines continue to vary among organizations, but the USPSTF updated its recommendation last year to say that most women should start getting mammograms earlier. These frequent shifts reflect ongoing research and the importance of personalized, informed conversations between patients and health care providers. Historically, an elevated PSA test led directly to a prostate biopsy, potentially causing unnecessary anxiety and sometimes overtreatment. Today, however, we have more advanced PSA-based tests that help better identify significant prostate cancers. Advanced imaging, like prostate MRI, allows us to pinpoint suspicious areas before performing a biopsy, increasing accuracy and decreasing unnecessary procedures. Biopsy techniques have also improved, some shifting from traditional transrectal biopsies to transperineal methods, reducing infection risks. Treatments have similarly evolved, emphasizing active surveillance of low-risk cancers and minimally invasive focal therapies. These advancements have significantly reduced side effects and improved quality of life, even among older patients. In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together. If your doctor hasn't initiated this conversation yet, it's important for you to bring it up. And remember, regardless of age, promptly inform your health care provider about any new urinary symptoms or health concerns. Staying proactive gives you the best chance to maintain good health this year and next.
Fox News
21-05-2025
- Health
- Fox News
DR. MARC SIEGEL: Biden's prostate cancer diagnosis reveals dangerous flaw in screening guidelines
If there is one thing that the COVID pandemic taught us, it was the lack of flexibility, nimbleness and the frequent inaccuracy or out of datedness of superimposed guidelines. I must confess that as a practicing internist for many years, I have never strictly adhered to guidelines and simply used them to guide me. Medicine is and always has been an art to be practiced on an individual basis. One of the guidelines that has bothered me the most is the U.S. Preventive Services Task Force Guideline – in use since 2012 -- not to recommend routine Prostate Specific Antigen use in prostate cancer screening. And even the American Urological Association doesn't recommend routine screening over the age of 70. Studies have shown that use of the PSA has fallen off likely in men over the age of 40 as a result of the USPSTF recommendation. This is particularly disturbing considering that there are over 300,000 new cases of prostate cancer in the U.S. diagnosed every year, with over 35,000 deaths, many of which may be preventable with earlier diagnosis. So it is disturbingly possible that former President Biden's spokesperson is telling the truth when he says that he wasn't screened for prostate cancer in over a decade prior to his current diagnosis of aggressive metastatic disease. Perhaps he and his doctors were just rigidly following an outdated and ill-conceived guideline. But this revelation, if true, is just as disturbing as if the Biden White House were hiding a timelier earlier diagnosis from the American public, just as they have apparently hidden other health realities regarding the former president. Delay and guessing in the dark is simply not how I, and many other internists and urologists, practice medicine. The PSA itself tells us when it trends upward, often when it increases over 4, that there is something going on in the prostate. The rise may or may not be due to prostate cancer. When combined with a "free PSA," if low, the likelihood of prostate cancer increases. We are also on the verge of genetic testing and liquid biopsies (blood tests) which will increase the accuracy of prostate cancer screening and we already have useful biomarker screening tests for prostate cancer in the urine. Luckily, despite the fact that current screening guidelines are not up-to-date or useful, I can still order a PSA and have Medicare cover it for any age if I say the test is medically necessary. I need to know that information, combined with a digital rectal exam looking for nodules, to know what to do next regardless of my patient's age. If either test is abnormal, I can then choose to proceed to an MRI of the prostate, which has become more accurate at looking for prostate cancer as the test has evolved and advanced. An MRI result can direct a urologist as to whether a biopsy is necessary and where in the prostate to direct this biopsy. If a patient has prostate cancer, there are many treatment options available, depending on the stage and aggressivity. These treatments have also advanced over the years and are better tolerated with fewer side effects, which means they may be tolerated by men of older ages and in poorer health. If a cure is possible, then either robotic radical prostatectomy or various forms of radiation treatments are considered. And if the prostate cancer is metastatic, as in President Joe Biden's case, hormone therapy to target testosterone (which may be causing the tumor to grow), may be used or combined with other treatments, including targeted therapies, immunotherapy, or chemotherapy. There are even studies which show that it may improve outcome to still remove the prostate even in some advanced cases. Many critics are saying that a president of the United States should have the most aggressive prostate cancer screening regardless simply because he is president. But I am saying that all men over the age of 45 should have this screening. Period. Regardless of age. Medical knowledge is power and what I do with the information I acquire to help my patient is the art of medicine. Not knowing is never the correct answer.
