Dear Guys (and the women who love us),
I’ve recently decided to let the little lobe (my prostate) do the thinking for the big lobe (my brain). As a result, I am not going to get a popular blood test for prostate cancer called Prostate Specific Antigen.
My brain, of course, thinks my prostate is an idiot not to get the PSA test. If we have a test for a cancer that kills 45,000 men each year why on earth would we not use it? My prostate, however, is happy to heed recent draft recommendations from the U.S. Preventive Services Task Force that men over 50 years of age do not routinely get PSA prostate cancer screening.
The reason this news has my prostate sighing with relief and telling my brain to smarten up or butt out of the issue, is because aggressive prostate cancer treatment is unnecessary for most men, and the treatment for prostate cancer is often worse than the disease.
If prostates could emerge into the sunshine and read, this is what they should peruse to help their brains distinguish fact from fiction in the Great Prostate Debate:
• The USPSTF draft report at uspreventiveservicestaskforce.org/draftrec3.htm, the most comprehensive review available of the whole issue, will point out that of 100 men diagnosed with prostate cancer, 97 will die of something else. For most men, prostate cancer is kind of a lazy, slowly progressive disease that will develop in almost all men who live to the age of 80. Aggressive prostate cancer is much less common, and there is little evidence that diagnosing it early with PSA testing improves the chance of survival.
It will also point out the problems with treating the more benign form of prostate cancer. Between 1986 and 2005 one million American men had surgery or radiation treatment for prostate cancer that would not have been diagnosed early without a screening PSA test. Of those, according to the USPSTF analysis, 5,000 died soon after from treatment complications, 200,000-300,000 suffered permanent impotence, incontinence or both as a result of treatment and 10,000-70,000 suffered other serious treatment complications.
• The credentials of the USPSTF members (uspreventiveservicestaskforce.org/members.htm), so you can ignore those — Sarah Palin, Newt Gingrich, etc — who say the USPSTF is just a government “death panel.” The membership of the panel, which makes preventive health screening recommendations on a wide range of important health issues, is made up of some of the best physicians from universities all over America. It is the same panel that has recommended in favor of screening some men for the potentially life-threatening condition abdominal aortic aneurysm (uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm). Its work is aimed at helping us be smart about our preventive care, not at helping “big government” deny us necessary medical care.
• The New York Times column by the physician who invented the PSA test (nytimes.com/2010/03/10/opinion/10Ablin.html), in which he calls PSA screening “a public health disaster” and urges the medical community to “confront this reality and stop the inappropriate use of PSA screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.”
• The New York Times Sunday Magazine article “Can Cancer Ever Be Ignored” (nytimes.com/2011/10/09/magazine/can-cancer-ever-be-ignored.html), for a great discussion of the prostate cancer treatment options from a man’s perspective.
• The American Cancer Society’s recommendations on PSA screening at cancer.org/Cancer/ProstateCancer/MoreInformation/ProstateCancerEarlyDetection/prostate-cancer-early-detection-acs-recommendations. Even the ACS, which is generally very aggressive in recommending cancer screening of various types, only recommends PSA testing for men over 50 who still want it after a discussion with their physician. It specifically recommends against PSA testing for men who do not have a 10-year life expectancy.
PSA screening and treatment are the kinds of complex issues a smart man will find a smart woman to help him sort out. Both should do some reading and talk with each other and a primary care provider, and both should ignore the pro-PSA screening hysteria that has followed the USPSTF draft recommendation.
The days of reflexive PSA screening for prostate cancer in all men over age 50, and of radiation or surgery treatment for most men who are diagnosed, should be over. My prostate is sighing with relief. (No, really, that was my prostate!)
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.