There was an interesting editiorial in the NYT today. As a man who was treated for Prostate cancer over 12 years ago, I often said that I had PSA disease. The problem in my opinion is not having PSA tests done. It is what happens after the results come back positive. The PSA test can provide a lot of value in determining if someone has prostate cancer and to a certain extent how aggressive that cancer may be particularly if the PSA is monitored over a period of time. The rate of change of PSA is an important indicator. The problem is that when a PSA is above a certain level (they were using 4.0 when I had my first PSA done at the age of 50 years), the next step is often a Biopsy to determine if there is cancer and to grade the Cancer. This is where the problem really comes into play. If cancer is detected (and the older you are the better chance that you will have some amount of prostate cancer), the next step is for the doctor to recommend ways for you to treat it. Top of the list is surgery followed by radiation of some time. My doctors do not really treat the possibility of what is called “watchful waiting” especially if you are young. Doctors do not want to take the chance that you, their patient, may be one of the people that have an aggressive form of the disease. The idea is that if the cancer is found early and the prostate removed or totally cooked with radiation, then you can no longer get prostate cancer. But even that is not always true. There is not just one kind of prostate cancer. Many prostate cancers grow very slowly and many never spread beyond the prostate (it has to do that to become dangerous). Frankly, I wish I never had treated my prostate cancer (I had radiation) but watched and waited (by monitoring the PSA and maybe having a biopsy ever few years) but at the age of 51 no doctor would have recommended that approach.
The good news is that i am pretty sure within ten years we will be able to determine of a man has an aggressive form of the disease or one that can be left alone which would be most cases. I also think we will find ways to deal more effectively with advanced prostate cancer which will mean that the cost of taking the risk will be reduced.