cancer / Health Care

PSA Testing Debate

There have been a number of recent articles in the press (most notably at the New York Times) about the advisability of giving men routine PSA tests to detect if they have Prostate Cancer.  A government panel has recommended that the practices of giving men over 50 (or over 40 if there is family history) be stopped because it results in needless procedures that are costly and effect men negatively without saving lives. I believe this is a dumb recommendation.  The PSA can provided valuable information that can save lives.  It is not the PSA test that is the problem it is what is done after the results come back that is the issue.  Those of you that are regular readers of my blog know that I have written a number of times about Prostate Cancer, a disease that I was treated for in 1996.  At that time I was 51 years old.  My PSA was 4.4 and had been gradually  increasing.  I had a biopsy that showed a Gleason Score of 6.  Today, my cancer would have been classified as low risk by most specialist.  Many would recommend that I would not be treated by that I would have active surveillance .  But many still would argue that I should  be treated and depending on their discipline (urologist, radiologist etc), they would have my prorate removed by surgery  or radiated either by external beam or implanted seeds.  I know that if I knew then what I know now, I would not have been treated at that time and may never have been treated.

I am convinced that most men who have Prostate  cancer will not die from it.  Prostate  cancer is probably not one disease by many and most are slow growing and will not spead.  If only we could tell which ones would have the aggressive version and treated only them.  But we cannot do that yet. I suspect we will be able to in the next ten years.  The problem in my view is not giving PSA tests to men.  The test is easy and inexpensive.  It is what happens with the data. Doctors are driving to prevent disease and seem willing to treat 100 men that do not need treatment to potentially save one that might.  And  most men finding out that they have prostate cancer, want it out of their body and sometime in the most aggressive way (surgery).  The side effects of treatment are in my opinion not properly communicated to patients.   You can read about the effect on sex life here.    What is crazy to me is that probably over 2/3s of these men are overweight and they could increase their life expectancy by loosing weigh and exercise.  That is what the doctor should be pushing.

My point of view is that PSA test should be given regularly.  If the PSA is high or rising quickly over time, a biopsy should be given.  If the Gleason Score is high (8 or more), treatment should be considered. The only treatment that makes sense for most men would be Brachytherapy.  I believe that there is good evidence that this treatment is both the easiest and most effective way of treat prostate cancer.   I can recommend Peter Grimm for this procedure.  Peter has a paper that will be published soon on the effectivity of most of the methods of treating prostate cancer which will be published soon. He will share it if you write to him here.   The practice of removing the  Prostate  by surgery should be stopped. It is barbaric.  When I first learned that I had prostate cancer, I was told it was the Gold Standard (the most effective method) but I think it was only the Gold Standard in that it put a lot of gold in certain doctors pockets.

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