The United States Preventive Services Task Force has advised against routine testing for prostate cancer for healthy men of all ages.
Essentially, for tests like the P.S.A. test (and mammograms, for those of us who were around the feminist blogosphere during the Great Mammogram Freakout of ’09), one has to weigh the benefits of earlier treatment against the costs of false positives and other unnecessary treatments.
Prostate cancer is one of the most common kinds of cancer for men. A third of men who die age forty to sixty have prostate cancer; three-fourths of men over the age of eighty-five have the same. Prostate cancer is the classic “you’ll live long enough to die of something else” cancer: it’s slow-growing enough in most cases that having prostate cancer is not that much of a risk. 1 in 6 men will be diagnosed with prostate cancer over the course of their lives; however, only about 32,000 men died of prostate cancer last year.
However, the risks of treatment are severe. From 1986 to 2005, one million men received treatment for prostate cancer who would not have otherwise received treatment without the P.S.A. test. Of this group:
- 5,000 died soon after surgery.
- Between 10,000 and 70,000 experienced post-surgical complications.
- 50% had persistent blood in their semen.
- 20%-30% suffered impotence, incontinence or both.
All for a disease that, statistically, is not actually that likely to kill you. In fact, multiple studies show that regular P.S.A. testing does not cut death rates over ten years. (While some studies suggest a slight improvement in mortality for men age 55 to 69, it has to be weighed against the risks of treatment.)
Many doctors, given the risks of treatment for slow-growing cancer, recommend “watchful waiting”: that is, after getting the PSA test, the doctor keeps an eye on the cancer but does not intervene. However, being diagnosed with cancer may cause extreme anxiety in patients. I mean, wouldn’t you be freaked out if you were diagnosed with cancer? Especially if your doctor said that they weren’t going to treat it? Not testing healthy men can give them peace of mind– which is also an important factor in health.
About ozyfrantz
“P.S.A. testing is most common in men over 70, and it is in that group that it is the most dangerous since such men usually have cancerous prostate cells but benefit the least from surgery and radiation.”
To me, this makes it sound like it might still be a good idea for middle-aged guys to get tested. If the problem is false positives, etc., shouldn’t the recommendation be to get tested multiple times by different physicians before attempting treatment? Seems like that’d be a safer route than not being tested at all.
This just says that PSA are not administered frequent enough to catch fast growing cancer in time to save more men, so it should be given every 6 months instead of every 12 months. It seems to me that if insurance companies paid for more frequent and inexpensive tests, doctors would be more willing to take a wait-and-see approach to collect more data on instead of treating it as a potentially lethal case straight away. If it takes less than a year for a really bad cancer to spread and tests are given annually, then the only choice doctors have is to either over-treat or to throw away every known medical procedure that could potentially save a man’s life. These recommendations were made by looking at statistics which they’re treating as gospel. Instead of asking actual doctors about ways to improve screenings and performing some long term studies to collect more detailed data, they’re acting as if they already had a complete understanding of the problem. Ultimately, saying that screenings do more harm than good is like saying that cigarette lighters cause lung cancer. It’s just stupid.
These sort of recommendations also fly in the face of the stereotype that men don’t go to the doctor enough. Someone’s going to have to make up their mind about which one is it, do they go too much or not enough?
@Druk
“shouldn’t the recommendation be to get tested multiple times by different physicians before attempting treatment? Seems like that’d be a safer route than not being tested at all.”
Until we have infinite nanobots providing medical care at the atomic level for every human we have to ask: Is there a more efficient (measured in lives saved per hour) use of doctor time?
This isn’t terribly surprising – here in the UK, the NHS doesn’t have a PSA screening program or indeed any kind of routine prostate cancer screening for exactly this reason, just as we have less aggressive breast cancer screening than the US did. (In fact I even seem to remember pointing this out during the feminist blogosphere’s rather interesting arguments about mammograms in 2009; some people back were arguing that it was based on the sexist idea that women were emotionally weak because prostate cancer wasn’t being handled the same way.)
I’m a bit surprised it took that long for them to change their advice though; it’s been fairly well known for some years that screening for prostate cancer is ineffective and the side-effects of treatment are unpleasant. On the other hand, this is one of the reasons the US can boast a higher cancer survival rate than places like the UK – it’s calculated as the percentage of diagnosed cancers that people survive, and the NHS doesn’t bother finding benign and low-risk cancers to the same extent as in the US.
Well, the doctor who invented the PSA test is one of the “stupid” people who now advocates this position – he has called the widespread use of the test a “public health disaster”.
Multiple screenings doesn’t necessarily help much at all, if false positives are systemic rather than random. And getting a positive from one doctor and a negative from another is going to be just great for the anxiety issue that ozy mentions in the post.
Most prostate cancers are not fast growing, so its not a question of checking more frequently to remove them “on time.” And the test can’t tell agressive cancers from non-agressive ones, anyway; only a biopsy, which comes with the nasty side-effects, can.
What’s actually needed is either a more accurate and informative test, a treatment with fewer side effects, or both.
The two are by no means incompatible. Men should be encouraged to see the doctor regularly, and when they do, doctors should only give them tests, treatments and so forth that are of net benefit to them.
Some studies show regular orgasms reduce the chance of prostate cancer. If you dont have a partner just make more time for yourself.
@YmcY, I don’t see how a comment from one doctor serves as anything more than an anecdote. Was he involved in the announcement? Does it tell us what most doctors think? I have no way of knowing. Does he treat patients directly, is he a public health expert, or is he reiterating the same viewpoint that was gathered from basic statistics? Your other points are well taken, but I would need further convincing that eliminating screenings is really the solution we want. I don’t know, I mean, as far as I know it could be like saying that sex spreads STDs so let’s eliminate sex.
Would it be terribly wrong of me to tout the prophylactic benefits of anti-androgens? ^_^