Should You Take the (P.S.A.) Prostate Test?

Two articles from last week's New York Times  starkly raise the question of whether it makes sense for healthy men to undergo prostate cancer screening. The United States Preventive Services Task Force has scientific evidence that the tests do more harm than good, but the entrenched practices of the medical establishment and some patient groups are fighting the pronouncement. Separately, an article in the Science Times simply reinforced for me the evidence of potential harm from over testing (see link below). The best way to understand the controversy is to read the articles yourself and do some critical thinking:

U.S. Panel Says No to Prostate Screening for Healthy Men

By GARDINER HARRIS

Published: October 6, 2011

Giving healthy men P.S.A. blood tests for prostate cancer does not save lives and often leads to treatment that can cause needless pain and side effects, a government panel said.

 

Panel’s Advice on Prostate Test Sets Up Battle

By GARDINER HARRIS

Published: October 7, 2011

A finding that a blood test to screen for prostate cancer does not save lives, but results in needless medical procedures, is being contested.

 

Health

Screening: Increased Risks After Prostate Biopsy

By NICHOLAS BAKALAR

Published: October 3, 2011

A prostate biopsy more than doubles the risk of being hospitalized for infections and other problems within the following month, a new study says.

 

Reading these articles about the studies on prostate cancer screening and the backlash they are causing really makes me question how science, medical technology, fear and greed all interact. It sure looks like the P.S.A. test is at best worthless for saving lives, and at worst, that it does more harm than good. The tests lead to far too many further tests that will not save your life, and in fact, can worsen its quality.

 

Yet, good people, doctors, insurance companies and policy makers all seem to be unwilling to try to understand the value of how statistical evidence can better guide our decisions. Even the articles show how quickly we turn to the small, individual stories that are easier for us to relate to, the anecdotes of lives being saved -- or of tests being avoided. 

 

But what none of these articles show are anecdotes from the people who had the further tests and treatments and had their lives wrecked as a result. If you're reading this and can provide such anecdotes, I will make sure they are posted because I believe we need to get a better handle on what the choices are. And we need to have some better ways to imagine the consequences of not following the scientific evidence which the United States Preventive Services Task Force has published.