Gentlemen, according to the Feds, prostate cancer screening for asymptomatic men appears to be worthless.
I can smell controversy in the air, and I hate controversy.
I like things to be open and shut, but medicine isn’t that way. It’s often messy. When new data comes out telling us we’ve been doing something wrong for years, no one celebrates. A good example was breast cancer surgery. When I went to med school, nearly every woman with breast cancer got a “radical mastectomy,” a terrible operation that often left women with chronically swollen painful arms and a disfigured chest. It took years before surgeons even considered changing. Doctors are, by nature, a conservative lot.
As for testing, we know that cervical, skin, breast and colon cancer screening saves lives. And what about the most common cancer, lung cancer? We don’t screen for it, yet it is the No. 1 cancer killer in the U.S., accounting for 60 percent of all cancer deaths. Back in 1970s, we did annual chest X-rays on smokers. When science said it was worthless, there was a lot of squawking but eventually we gave up that practice.
Back to the prostate cancer test, or PSA. It’s always been controversial because it’s sometimes positive when there’s no cancer and sometimes negative when there is. And then there’s the prostate biopsy, which is done through the rectum.
Unfortunately the cancer biopsy grading system, though useful, does not tell us who will die from prostate cancer.
So what’s the harm? Well, there is the psychological trauma of knowing that you have cancer and worrying that it will kill you, even though we know most men will not die from it. And then there’s the potential side effects from surgery – erectile dysfunction, dribbling, diapers for some and death for others.
Yes, the surgery has improved, but it’s not 100 percent. And for those who choose radiation, that has side effects as well.
The Feds here are the U.S. Preventive Services Task Force scientists, statisticians and doctors, who create guidelines telling us what we should test for – diabetes, cholesterol, heart disease, cancer – and they recommend immunizations, too.
They gave the PSA a “D.” This means they “recommend against PSA testing as there is a moderate or high certainty that it has no net benefit or that the harms outweigh the benefits.”
Ninety-five percent of men with PSA-detected cancer followed for 12 years did not die from the cancer, even if they had no treatment at all.
For men over 70, there was no evidence that prostate cancer screening affects mortality at all. For men under 70, improvement in longevity was small to none. The committee chairman said, “We have no good evidence that PSA screening does any good, though we hold out hope that there may be a small benefit.”
This is controversy? There are well-meaning physicians, special interests and concerned consumers putting up websites claiming that the fed is wrong. They’re not always right.
My spin: Sit down with your doc and have a robust discussion and then you make the call whether to be tested. But I predict that the PSA is going to go the way of the annual chest X-ray.
Dr. Zorba Paster is a family physician, professor, author and broadcast journalist. He hosts a radio call-in show at 3 p.m. Saturdays on WBFO-FM 88.7.