Debate about prostate tests rages

“This article from North Caroloina highlights the issues involoved in the PSA debate that continues to affect the lives of patients in Miami and around the country.” David Robbins

Debate about prostate tests rages

 
 
By: RICHARD CRAVER | Winston-Salem Journal
Published: November 19, 2011

Turning 50 proved to be a milestone for Mike Tyson not just in terms of age.

Tyson, of Winston-Salem, credits the symbolic birthday for saving his life because he chose to undergo a routine prostate-specific antigen test at that time. The test measures a specific protein released by prostate cells.

Because his PSA level was elevated for his age, Tyson underwent a biopsy that revealed prostate cancer. He had surgery in February.

He said his recovery was slow but that in August, he began feeling more like himself, particularly after participating in the Livestrong program for cancer patients and survivors at local YMCAs.

The necessity of the PSA test — and the consequences of what it might reveal — has become a significant topic at local urologist offices since October, when the U.S. Preventive Services Task Force recommended against it.

For men, prostate cancer is second only to skin cancer in frequency of cancer cases. It also is the second leading cause of death, behind lung cancer.

In 2009, health-care lobbying groups criticized the task force for recommending that most women wait until age 50 to get mammograms and then have one every two years. The American Cancer Society’s longstanding recommendation is annual screening starting at 40.

Opponents of the PSA test say it tends to lead to potential misdiagnosis and unnecessary biopsies and treatment for men, particularly for those 50 and older. They say urologists support PSA testing because it can be a significant revenue source.

After conducting five clinical PSA trials, the task force said, “There is moderate or high certainty that the service has no net benefit and that the harms outweigh the benefits.” According to a New York Times report, the task force said the test “cannot tell the difference between cancers that will and will not affect a man during his natural lifetime.”

Proponents point to examples, such as Tyson, as to why the test is pertinent.

Tyson said he’s convinced PSA testing is not only necessary but should be done sooner.

“I had no symptoms of prostate cancer,” Tyson said. “Having my wife die of bone cancer in February 2008 after fighting it valiantly for seven years, and with an 11-year-old daughter to care for, I didn’t consider anything other than surgery.

“If I had gone with the watch-and-wait approach, I might not have been checked for months, if not years, because of being 50. Who knows how much the prostate cancer could have spread in that time?”

Urologists affiliated with Forsyth and Wake Forest Baptist medical centers support the stance of the American Urological Association.

“Until there is a better widespread test for this potentially devastating disease, the task force — by disparaging the test — is doing a great disservice to the men worldwide who may benefit from the PSA test,” said Dr. Sushil Lacy, president of the association.

“It is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, or risk assessment and monitoring of prostate cancer patients.”

This issue isn’t one that affects just urologists, said Karen Richardson, a spokeswoman for Wake Forest Baptist. “Many men get their prostate cancer screenings from their primary-care physicians,” she said.

Dr. Jeremy Hubbard, a urologist at Carolina Urological Associates, said he disagrees with the task force’s recommendation because it is a sweeping declaration for a decision that is individual in nature.

“We’re concerned that some patients — and some primary physicians — may only consider the task force’s recommendations and not access all the pertinent information they may need,” Hubbard said.

In 2008, the task force recommended against PSA testing in men ages 75 or older, relying instead on the watch-and-wait approach because treating the prostate cancer for men of that age could cause more harm than the disease itself.

Hubbard said that because some prostate cancer is slow to grow, “it requires reasonable active surveillance by physician and patient.”

“Treatment recommendations for someone with prostate cancer are different for someone in their 40s and 50s compared with 60s and 70s,” he said.

The American Council on Science and Health supported the task force’s recommendations because it said tens of thousands of men have had serious complications from unnecessary prostate surgery, ranging from blood in the urine to incontinence and impotence, and even death.

Dr. Gilbert Ross of the council said a more specific test for prostate cancer is needed — one that will identify only cancer cells that are likely to develop into dangerous tumors and metastases.

“The PSA test should not continue to wreak so much havoc on people’s lives,” Ross said.

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