About 10 years ago, my dad was to see his general internist. I have always refrained from giving medical advice to my family, for all of the reasons why doctors should not treat or advise their relatives. But, on this occasion, I did give Dad some unsolicited advice, particularly as I knew that his physician fired the diagnostic testing trigger readily.
“Dad, please make sure that he doesn’t check the PSA (prostate specific antigen) test.” Dad indicated that he would convey my concern to his doctor, who ran the test on him anyway. Apparently, he includes the PSA test as a matter of routine on all men over a certain age.
Twenty-five years ago as a curious, but skeptical medical student, I learned about prostate cancer. I learned that every man will develop it if he lives long enough. I learned that most cases of prostate cancer remain silent and never interfere with the individual’s life. I learned that the treatment for these cancers involves either major surgery or radiation, both of which can markedly diminish the quality of mens’ lives by causing urinary leakage, chronic diarrhea and rectal bleeding and sexual dysfunction. These lessons are just as true in 2009, yet they are largely ignored by a juggernaut of physicians, medical societies and hospitals, who have conflicts of interest on this issue. These PSA proponents are not corrupt, they are just blinded by their biases.
Men are strongly urged to pursue early diagnosis of prostate cancer under the false premise that this will lengthen and improve their lives. The PSA test, which is championed by so many physicians, has achieved exactly the opposite results. It has been an entry point for men who are pushed down a slippery slope into a medical minefield. Like many medical cascades, it is very difficult to change the course of this journey once it has begun. Once a PSA value is abnormal, it becomes almost impossible for patients and physicians to resist the pressure for prostate ultrasounds and biopies. The time to discuss prostate screening with patients in detail is before the blood test is done, not afterwards when the result is elevated or borderline.
The treatments for prostate cancer harm thousands of men across the country, most of whom would never have been disturbed by their silent cancers. This is a true medical travesty. Urologists and others dispute my views and earnestly believe that they are saving lives. I believe they are sincere and properly motivated. Yet, while they may be saving a few men, this must be balanced against the direct harm, financial cost and anxiety of patients and their families that are ultimate PSA casualties. Personally, I am mystified why the PSA screening test wasn’t banned from medical practice years ago.
Here’s what a study published in the prestigious New England Journal of Medicine concluded earlier this year. In order to save a single life from prostate cancer, about 1400 men would have to be screened. How do those odds sound? Read on. About 50 of these men would endure prostate cancer treatments, as I described above, that would not benefit them, either because the disease would have remained silent or was already too advanced to be helped medically. Still interested in getting a PSA test?
It’s a tragedy when a patient suffers chronic complications from a treatment that was not necessary. If comparative effectiveness research, which aims to scientifically determine which medical treatments are supported by evidence, ever gets airborne, I hope that PSA becomes a very high priority item.
PSA testing is a complex issue and calls for discussion between patients and physicians before any testing is undertaken. It should not be casually added to a panel of blood tests, deferring the conversation until afterwards, when it may be too late to derail the prostate locomotive.
The PSA is more accurately a Physician Scam Activity, than it is a lifesaving screening test, even though the physicians’ intentions may be pure.
When your doctor advises any test, particularly the PSA, make sure that you understand where the result could lead you. Regrettably, many men like my dad have the test sent off without their knowledge. Fortunately, his PSA result was normal. Otherwise, the prostate train may have taken him into a tunnel with no way out.