The Doubt in Preventive Screenings
I know several men a few years older than me who learned via a PSA test that they had likelihood of prostate cancer. All went through the options and had the cancer treated and have an excellent prognosis. But two new studies–one in the U.S. and one in Europe– raise the question of whether they or thousands of middle-aged men needed the screen, or the treatment.
Cancer researchers have known that many cases of prostate cancer are too slow to pose significant risk of death. Of course any such risk has to be balanced by the risk of treatment, which in the case of prostate cancer may involve impotence, incontinence and other painful results. The European study found that for every man whose death was prevented, 48 received unnecessary treatment.
The obvious need is for more precise tests to determine whether the cancer is aggressive. In a larger sense the studies bring up ethical questions of what screenings are intended to do. If they are defined as merely indications or early warning signs, at what level of danger are they effective? For now, at least, there is some data that men faced with a positive test can use to determine what is right for them.
About the Author: Jim Molpus is Editor-in-Chief of HealthLeaders Media, and is responsible for the editorial direction of the company's print, online and conference products.
drsteventucker | Apr 8, 2009 | Reply
It is always glad to know your friends or anyone has a great prognosis, but a major point here is that the overwhelming number of men with PSA-detected prostate cancer have an excellent prognosis. And that is both regardless of treatment or despite treatment. Before considering screening we need to consider the treatment choices and their attendant side effects. Cure or no cure barely effects survival but attempt at cure (as compared with active surveillance) has a dramatic effect on quality-of-life. There is just no simple answer for this (or mammography) and it takes time and wisdom to help each patient one at a time.