The Curbsiders Internal Medicine Podcast #506 DIGEST-Hotcakes: PSA Screening, Acetaminophen and Autism, COVID19 Vaccines and Cancer, Aspirin and Anticoagulation in Coronary Artery Disease
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Dec 1, 2025 
Dr. Adam Cifu, a professor of medicine and general internist, joins the hosts to tackle a stack of intriguing topics. They dissect recent findings on PSA screening, revealing a strong push for shared decision-making rather than changing current practices. The discussion shifts to a systematic review suggesting a potential link between prenatal acetaminophen and neurodevelopmental disorders; the panel advises caution in interpreting these findings. Finally, they examine the AQUATIC trial, advocating against combining aspirin with anticoagulants in chronic coronary syndrome due to increased risks.
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Clinician Skepticism And Real-World PSA Choices
- Paul Nelson-Williams and colleagues noted PSA screening has been widely disliked and practice varies despite guideline shifts.
- Clinicians often find men opt for testing after brief counseling, reflecting real-world decision dynamics.
Modern Tools Don't Erase Overdiagnosis
- Improvements like MRI and active surveillance reduce overtreatment compared with older screening-era practices.
- Yet the small absolute mortality benefit means broad screening still risks diagnosing many men who won't benefit.
Use Shared Decision-Making For PSA
- Continue shared decision-making: discuss PSA screening risks and uncertain benefits with eligible men.
- Individualize testing frequency and candidacy rather than adopting universal screening.