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.