Merrill Goozner reminds us of why so many dollars are wasted in the US health care system. The prostate cancer scare is exhibit one in the ability of device manufacturers, pharma, and advocates thereof to raise America’s health care costs with their voodoo medicine.
Prostate cancer is usually a very slow growing cancer; many men over sixty have it and few will die of it. Of course some will die young, but overall, far more men (and their loved ones) are harmed by misdiagnoses of prostate cancer and the potentially horrible effects of unnecessary treatment than actually benefit from early detection.
The ugly truth about prostate cancer testing is it doesn’t work. The most common test, a blood test known as PSA (Prostate Specific Antigen) is terribly inaccurate. Men who have been tested have no better survival rate than men who have not.
This isn’t my opinion, it is the finding of research published in The Archives of Internal Medicine in 2006. The authors found that neither a PSA test, nor a rectal exam reduced the chance of death from prostate cancer. And the latest data confirm that testing is a huge waste of money and is wildly inaccurate
OK, so what’s the problem? Men get tested, no harm no foul? Actually there are lots of problems. First they aren’t free – PSA tests range in cost from $70 – $200, dollars that could be saved or spent on more effective medical services. OK, what happens if you decide the heck with the cost, I’m going to get a PSA test. The PSA level can be abnormal even when a man does not have prostate cancer. Seventy percent of positive PSA tests are false positives; the patient does not have prostate cancer.
Not only is this a huge waste of money, but patients who undergo treatment (radiation and/or surgery) may well end up impotent (38% – 63%) or incontinent (13% to 52%) or have bowel issues (5% to 17%). As a fifty year old man, I don’t much like those odds.
What’s even worse is when regular people become unwitting advocates for these charlatans. As I noted several months ago, one of hte more ardent advocates of early prostate cancer screening is Ed Randall, host of the terrific ‘Talking Baseball’ radio show. I’m a big fan of his show, and equally angry about the damage Randall is doing to individuals, their families, and the nation with his unabashed, and ill-informed, support for prostate cancer screening.
I’ve contacted Randall in an attempt to discuss this, but never got a response. The title of this post may be considered inflammatory and over the top. So be it.
What does this mean for you?
Don’t get a PSA test.
Mar
24
I couldn’t disagree more. As a Prostate Cancer Survivor, I was tested and found to have a low PSA, but over time was increasing by adnormal percentages. This is what triggered the PCP to recommend a Surgeon who was reluctant to take further action until another year of increasing numbers. At that point, a Biopsy was conducted with the Surgeon convinced it would show BPH. It did however show Cancer in a lower stage but higher Gleason score. After researching my options, with no direction from the Surgeon to engage in surgery, I made the choice to have it removed before it grew further or cells leaked into other organ areas. Yes, one could make the arguement that about 20% of those who pursue watchful waiting will die of Prostate Cancer while 80% will die of something else, but I didn’t accept that gamble. I decided to remove it. Having said that I have not experienced any side effects. Today, the best Surgeons are very good at nerve sparring and incontinence.
I would also tell you that I had a family friend who in the 70s commited suicide having tolerated such extreme pain and suffering from prostate Cancer that he couldn’t take it any longer.
I cannot dispute your statistics as I have not seen the study you are quoting, but I can say that the research provided by Dr Peter Albertsen, Urology, UConn Med Ctr was quite different. Radiation does cause peripheral and collateral damage that can take up to three years to manifest, however, Surgery and removal has far better statistics these past 5 years.
As we know many more men have been tested and diagnosed than ever before, and time has not passed long enough to factually determine whether those cases improved mortality statistics or not. And, I would not be an advocate for those men gambling on being in that 20% or so that waited and ignored the reality of cancer, only to either die from it or have it spread to other organs.
My sister in law was diagnosed with Cancer of her Eye – Occular Melanoma. Great work was done at Mass General to radiate the eye and shrink the tumor, however, they decided not to do a CT Scan of her head of liver even though 90% of those with this cancer result in aggressive cancer in one or the other place. Two years later she is dead from inoperable Liver Cancer. Back at the beginning a CT Scan as a baseline would or could have shown if there was anything in the liver and it may have been operable. She was 58 when she died.
I hope you never have to personally experience cancer. But, if and when you do, I suspect you won’t care about the $70 tests or even more expensive Surgery if it can save your life.
I would encourage you to contact Dr Albertsen at UConn Urology and discuss his research and the statistics he is experiencing.
This article is chilling. My brother is suffering from the aftermath of prostate cancer therapy. Radioactive seeds were implanted while he was in his late 50’s, early 60’s. Ten years later, his urethra has been so compressed by scarification that has had its sphincter removed and five (!!) stents implanted over a course of three surgeries. Next surgery will install an artificial sphincter will be installed and the surgery after that will install a bulb-like control device inside his scrotum to open the sphincter (which subsequently closes on its own).
I plan to let PC take me in its own time, if it shows up, rather than risk what my brother has and will suffer.
Guys: Don’t stick your heads in the sand by avoiding PSA testing as suggested above. You can play a role in trying to avoid death by prostate cancer — an ugly death suffered by tens of thousands of men every year. It begins with screen PSA and DRE. But screen can at best be a warning sign that you need to look further. Of course don’t be stupid and base any treatment decisions on a PSA reading or any of the more sophisticated approaches that have been developed since the studies being reported. Next perhaps a biopsy if the screening suggests it is needed. Now you are beginning to learn something. Find a good Dr. get a second opinion at a major center, attempt to evaluate your situation and what to do — continued surveillance of any of the more agressive modern treatments developed since the contaminated incomplete “studies” (Half of the men in the control group also had PSA testing!!!) and if your life expectancy is more than 5 to 10 years the studies are useless re slow growing prostate cancer. Gentlemen — knowledge is our best approach not playing an ostrich with your head in the sand pretending prostate cancer can’t hit you and PSA tests don’t tell you anything.