September is Prostate Cancer Awareness Month. As such, men have been bombarded with public service announcements urging them to get tested for prostate cancer.
Some doctors and medical organizations urge men to start getting tested at age 50, others as early as 45 or even 40. Since my driver’s license tells me I’m 50 years old now, I thought I’d better look into the test. I hopped on the computer and did a little Google search.
What I found is that the test for prostate cancer is called a PSA (prostate-specific antigen) screening. More importantly, I also discovered the PSA test results in a lot of false positives and that two of the early founders of the PSA, Dr. Thomas Stamey and Dr. Richard Ablin, no longer recommend using the PSA as a screening for prostate cancer. In fact, Stamey fears the tests are leading to unnecessary treatment and worry.
Until I did some digging on the PSA, I naively thought that if I took the screening test the doctor could tell me if I had prostate cancer or not. Unfortunately, it’s much more complicated than that. The PSA is far from a perfect diagnostic tool and reasonable men can easily decide that the potential risks outweigh the benefits.
The issue is that the vast majority of prostate cancers grow slowly and are never a threat. Moreover, even for the fast-growing prostate cancers, early diagnosis might be too late. At any rate, the PSA simply can’t differentiate between harmless cancers and dangerous cancers.
Results from two large studies – one in Europe and one in the United States – that were designed to examine the effectiveness of the PSA test were published in the New England Journal of Medicine earlier this year. In both studies, participants were randomly assigned to one of two groups – one screened with the PSA test and the other not.
The American study found no reduction in deaths from prostate cancer in the PSA group. The European study found a small reduction in prostate cancer deaths in the PSA group. But the number of lives saved was small, seven fewer deaths from prostate cancer for every 10,000 men screened.
In another study, H. Gilbert Welch, M.D., professor of medicine at Dartmouth University, and Peter C. Albertsen, M.D., a urologist at the University of Connecticut, analyzed data on prostate cancer collected by the National Cancer Institute along with data from the U.S. Census. They published their findings this summer.
“For every man who avoids a prostate cancer death due to PSA screening, about 50 men have to be treated unnecessarily – and a third of these men will have serious problems with treatment,” concluded Welch, who’s study suggests that since 1986 nearly 1 million American men have suffered needless treatment for prostate cancer after taking the PSA. The serious problems Welch refers to include the inability to have an erection or orgasm and lifelong incontinence.
Los Angeles urologist Dr. Alan Shapiro says, “The PSA test has done much more harm than good.”
Dr. Stamey chimes in, “The PSA era is over in the United States.”
But as the numerous public service announcements urging men to get screened suggest, the PSA era is far from over. Most urologists in the United States still recommend taking the PSA test because they claim that despite its flaws it’s the best tool we’ve got. And undoubtedly, some lives have been saved due to PSA screening.
So, where does that leave those of us wondering if we should be screened or not?
The American Cancer Society encourages men to talk to their physicians about the risks and benefits of PSA testing – including the potential for unnecessary treatment – and then make the decision that best suits the individual.
“Now we actually have something to inform them with,” says Dr. Otis Brawley, the chief medical officer of the American Cancer Society. “We’ve got numbers.”
According to Welch, “The real issue is, do you want to play this game?”
Ken Reed is a Denver-based writer. EDITOR’S NOTE: This is an online-only column and has not been edited.
