Does PSA Testing Save Lives or Not? - Part II

Yesterday's post highlighted the controversy about screening healthy men for prostate cancer using the PSA test. The media does the public a disservice by claiming such testing does not save lives. It does. The issue is: at what price?

Imagine a man who has no symptoms, a normal prostate exam, and an elevated PSA due to early prostate cancer that would have acted aggressively, but is cured with treatment. This man's life has be saved by the screening PSA.

The problem is that today's technology cannot distinguish prostate cancer that needs treatment from cancer that would have never caused illness, so most  men newly diagnosed receive treatment.

The problem is that today's treatments for early prostate cancer carry significant risks of life-long impotence and incontinence, as well as other long-term problems, depending on the type of treatment.

The problem is that many aggressive cancers, even if seemingly found early, are still too late to be cured with curative therapies. These patients deal with treatment, only to have their cancer recur and spread anyway.

The problem is that prostate survivors who advocate for PSA screening may be motivated, at least in part, by their need to feel the PSA screening and subsequent treatments saved their life. To consider the possibility that maybe they didn't need the treatment is to risk feeling a host of negative emotions, not the least of which are anger and regret.

Check out today's NYTimes Magazine for an excellent piece on the topic: Can Cancer Ever Be Ignored?

Comments

[Finn]

The same issue arose when the USPSTF changed its mammogram recommendations for women at normal risk not to start screening until age 50, and to repeat every second year instead of yearly. Women whose mammograms found DCIS, subsequently removed, believe the screening and surgery saved their lives, but the state of the science is such that we do not know which of those cases would have progressed and which wouldn't have.

Unfortunately, until we are able to differentiate between cancers that will progress and cancers that won't, we're stuck with only 2 options: aggressive treatment that may actually be unnecessary, or the high-stakes gamble of foregoing treatment.