Over the past few days, several news articles detailed a new warning from the U.S. Preventive Services Task Force about the prostate-specific antigen test (PSA) which doctors utilize to screen men for prostate cancer (PC). The warning, which recommends not taking the test, mirrored a similar announcement by the Task Force about mammograms, in which women aged 40 to 49 were advised not to take mammograms.
Many doctors are denouncing the PSA warning, as PC is the second most prevalent form of cancer effecting males. The recommended treatment of common diseases such as breast cancer and prostate cancer should be of interest to older and younger Americans alike; we will all be challenged by these maladies as we age.
The Task Force is a panel of U.S. health care experts funded by the Department of Health which conducts scientific evidence reviews of a broad range of clinical preventive health care services. A New York Times article summarized the Task Force recommendation as follows: "Healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives overall and often leads to more tests and treatments that needlessly cause pain, impotence, and incontinence in many [men]...." The Task Force is effectively suggesting that early efforts to diagnose PC are not relevant to male survival rates and result in undue pain and suffering.
Some 44 million men in the U.S. are 50 years or older, 33 million of who have already taken a PSA test. The test was first approved in 1986 and measures the amount of prostate-specific antigens released by prostate cells, a universally accepted means of identifying cancer cells. From 1986 to 2005, one million men had prostate surgery, radiation therapy, or both who would not have been treated without a PSA test. Among them, 5,000 died soon after surgery and 10,000 to 70,000 men suffered serious complications. Two hundred thousand men were diagnosed with PC in 2010; 32,000 died from the disease. Death is rare before 50 years of age, and most fatalities occur in men over 75.
Another New York Times story focuses on a number of people who are skeptical of the PSA test, which is part of a multibillion-dollar industry that screens for PC. Prior to surgery and radiation, doctors routinely perform the PSA test, a digital examination, and follow-up biopsies of the prostate if the PSA level is elevated or if the doctor feels anything suspicious during the examination of the prostate. The article indicates that “far more men die with PC than from it, and only a tiny fraction of PC’s ever cause symptoms, much less death.”
After digesting this information, it would not be surprising if many men become more hesitant about prostate screening. Some doctors think this trend could result in more pain, suffering, and death. Younger men and their loved ones should be familiar with the most important health issues that will likely affect them and their families as well as the involvement of the federal government in these matters.
In an effort to gain some clarity, I contacted Dr. Alan W. Partin, professor and director of the Brady Urological Institute at Johns Hopkins Medical Institute, the top rated urology department in the country (disclosure: I am a director of the Johns Hopkins Prostate Cancer Foundation). It is the opinion of Partin that the recommendations by the Task Force are not in the best interests of men. Dr. Partin said a 40% decrease in PC deaths since the PSA test was developed is, in fact, justification that the test is a useful marker for PC. He articulated a number of reservations about the research used in the preparation of the Task Force’s recommendation.
A paper prepared by Johns Hopkins recommending PSA testing indicates that “in 1990, before there was PSA testing, only 68% of newly diagnosed men had cancer that was localized to the prostate and 21% had metastatic disease to bone. Today, 91% of patients are diagnosed with localized disease and 4% have metastases.” The “ability to diagnose the disease at a curable stage coupled with improvements in both surgery and radiation therapy” has resulted in a 40% decline in PC deaths in the last 10 years.
Men must decide whether they want to roll the dice and wait for symptoms of the disease before being tested. Unfortunately, symptoms are only evident after PC has spread; the chance of death increases exponentially at this point. It is true, however, that PC usually grows at a slow pace. Most men will develop PC if they live long enough, but will likely die from another affliction. Screening effectively weeds out the unfortunate men who will die from PC if it is not treated.
If you are a 30-year-old man, prostate cancer is probably not something you have discussed with your doctor yet. However, you will by age 40, and your father, uncles, older brothers, and male friends may already be deeply entrenched in dealing with this issue. And remember, all men are going to contract PC if we live long enough. It makes sense to ensure that we are not one of those who will die from the disease if it is not treated.
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