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A Times Editorial

Recognizing the perils of needless prostate tests

We live in extraordinary times of wondrous breakthroughs in medical science that combat a litany of maladies once viewed as potential death sentences. But as a new federal government study on prostate cancer argues, simply because the technology exists to diagnose a medical condition doesn't necessarily mean that men should seek out treatment, which may end up being worse than the disease.

The draft findings of five clinical trials issued by the U.S. Preventive Services Task Force may seem counterintuitive and threaten a multibillion-dollar medical industry in the diagnosis and treatment of prostate cancer. Nevertheless, the task force, an independent panel of medical experts convened by the U.S. Department of Health and Human Services, recommends that healthy men should no longer concern themselves with getting screened for prostate cancer since the test does not save lives and more often leads to unnecessary treatment resulting in incontinence, impotence and needless pain.

In short, when it comes to prostate cancer and men: Ignorance may truly be bliss, since a positive diagnosis also can lead to unnecessary psychological stress.

The task force findings noted the current PSA test administered to men, which measures the prostate-specific antigen protein, does measure the potential presence of cancerous cells. But the study also concluded a vast majority of otherwise healthy men who are not demonstrating any symptoms of a cancerous prostate never experience any ill effects since the cancer is so slow-growing. Chances are most men will die of some other affliction long before the cancerous prostate has a chance to grow to life-threatening proportions.

Yet a prostate cancer diagnosis by way of a PSA test can lead to overly aggressive treatment by doctors who recommend surgery or radiation therapy or both, with devastating and needless consequences. Among the 1 million men aggressively treated for prostate cancer between 1986 and 2005, 5,000 soon died, 70,000 experienced complications and between 200,000 and 300,000 patients suffered from incontinence and/or impotence. Nor did the studies determine if prostate cancer treatment resulted in any measurable improvement in the mortality rate among patients. Even Dr. Richard J. Ablin, the PSA test's creator, has called the posttreatment effects on prostate cancer patients a "public health disaster."

What should you do if you are among the estimated 11 million men over the age of 50 in the United States who have not presented any prostate cancer symptoms and have not yet submitted to a PSA test? According to the task force's pragmatic conclusions, nothing.

The PSA clinical trial findings are sure to set off a debate within the medical community, just as a similar 2009 task force did in recommending that healthy women under 50, who are also not experiencing symptoms of breast cancer or don't have a family history of the disease, should forgo routine mammograms.

Ultimately the task force recommendations put the onus on whether to submit to a PSA test squarely on the individual patient. Fortunately for most men, it would seem there's plenty of time to think about it.

Recognizing the perils of needless prostate tests 10/07/11 [Last modified: Friday, October 7, 2011 5:49pm]
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