The Government’s War Against Men’s Health is About to Get Much Worse (by Benjamin Davies, MD)

Benjamin Davies, MD, is an Associate Professor of Urology at the University of Pittsburgh, School Of Medicine.

Low in a valley bound by strip-mined mountains the gritty post-industrial city of Uniontown, Pennsylvania, lies poised for re-invention. The city has the forlorn look of a past gem struggling to maintain a forward posture. Strip malls overwhelm the pastoral beauty of the surrounding geography. A strong palette of grey and black dominates the low-lying city as if struggling to breathe in some color.

Uniontown is the birthplace of the Big Mac; a factoid perhaps best forgotten as the populace has strained under the common endemics of obesity, malnutrition and substance abuse. It was in a recent clinic in Uniontown that I met a bright middle-aged man with widespread metastatic prostate cancer. Lucky to have found a recent job at the local mill, he failed his physical when the nurse practitioner examined him. Unable to urinate properly, his bladder was easily palpated on examination and he was sent to the hospital. My care for him has been to ease his symptoms. He will die in less than a year.

The Centers of Medicare and Medicaid services (CMS) is proposing using PSA screening as a quality metric for payments to providers. If enacted, your primary care physician will be monetized to not screen you for prostate cancer. This is an inevitable downstream effect of the largely discredited and intellectually lazy United States Preventive Task Force Recommendation (USPSTF) Grade D against screening for prostate cancer. That should scare you. That should scare everyone who loves men.

Prepare for the rates of metastatic prostate cancer to rise. The effect of widespread PSA screening in the 1980s was the immediate and rapid decrease in metastatic prostate cancer cases — the same cannot be said of screening for breast cancer (which has a Grade B recommendation). Intellectual consistency is not the USPSTF forte.

Consider the below graphs just published in the New England Journal of Medicine that illustrates the point.

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