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Ignore the new prostate cancer guidelines


Never in the history of Quizzify have we proposed ignoring guidelines, but the National Comprehensive Cancer Network just backtracked its guidelines for low-risk localized prostate cancer from saying “active surveillance is preferred,” to telling doctors they should equally weigh and propose radiation therapy, surgery, and surveillance for those cancers.


This is like in the old days (meaning 10+ years ago) when lots of surgeries were done on prostates, with basically nothing to show for them other than impotence, incontinence, depression, surgical complications, and – lest we forget – bills. Likely a few lives were saved, but as Dr. Otis Brawley, former Chief Medical Officer for the National Cancer Society says: “Prostate screening is 50 times more likely to ruin your life than save it.”


This new/old guideline isn’t literally about screening. This guideline is about treatment. Nonetheless, these low-risk localized cancers are mostly found through screening, since they mostly wouldn’t produce symptoms. Ergo, routine screening should not be done. “Routine screening” means “screen all comers” of a certain age bracket," as you might do for blood pressure.


Of course, there will be exceptions, employees who decide, in consultation with their PCP, that they should be tested. But that’s not screening. That’s making a decision to do a test based on evidence and discussion.


Screening is the opposite. No individual patient evidence is involved, and no consult is involved. Screening is only useful if the answer to all three of these questions is “Yes”:

  1. Can you find things that otherwise wouldn’t be found?

  2. Can finding those things early improve outcomes?

  3. Are there enough true positives to outweigh the false positives?

The answers for prostate screening are:

  1. Yes. But most of those things should be left alone. Most males who die of something else have some cancer cells in their prostates that are doing them no harm.

  2. It depends. Is it worth ruining fifty employees’ lives to save one?

  3. This is also a question where the answer would be subjective.

We would say that at the very least, based on those answers and non-answers, that employers and wellness vendors should not be involved in this decision. This decision should stay between the patient and the doctor.

If you find this kind of evidence-based discussion distasteful, you’ll hate Quizzify. And vice-versa. That's because all our material is evidence-based.


Watch our new video at https://www.youtube.com/watch?v=xLWAs1WWlY4. Just to set your expectations low enough that we can easily exceed them, this is the second-best healthcare vendor video ever produced.


Or you can cut to the chase and contact us directly.