To PSA or not PSA (Sujatha)

Remember the great Mammo or no Mammo debate that erupted a couple of years ago? The task force is back in action again. This time they recommend 'No PSA', as the evidence builds up that the cure is worse than the disease.

"The U.S. Preventive Services Task Force examined all the evidence and found little if any reduction in deaths from routine PSA screening. But it did conclude that too many men are diagnosed with tumors that never would have killed them and suffer serious side effects from resulting treatment."

From the New York Times:

"As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a “public health disaster.”  (italics mine)

There is a flourishing industry whose success depends on treating the incontinence and impotence that is such a common side effect of those who have undergone treatment for the possible prostate cancer, whether slow-growing or fast.

The real question, at this point, given the weak economy, is whether the bending of the health care cost curve tthat comes from less aggressive testing for prostate and breast cancers is worth the loss of jobs in the healthcare and pharmaceutical industries. Maybe it is worth it, in terms of quality of life for say 48 out of 50 who might have been diagnosed on the basis of the test, and subjected to needless treatment. But the 2 who were saved will always be much more vociferous in their support of universal testing, as is very evident from the flurry of angry letters following the articles.

Or maybe, they should just let things be between men and their doctors, just as in the case of women and the mammogram recommendations.

Comments

[Ruchira]

Now this. The indictment goes well beyond Vitamin E.

(I have tried posting this comment thrice. Each time TypePad has disappeared it. If others are having the same problem, let me know)

[Sujatha]

The Vitamin E contributes to prostate cancer was definitely a shocker, coming on the heels of the indictment of multivitamins for older women. Eat your fruits and veggies, rather than relying on magic pills, seems to be the new mantra here. Or will they next find out that it has to be organic fruits and veggies vs. ordinary farmed produce?