Take On The Prostate
by ilene - March 14th, 2010 7:27 pm
Over a decade ago, I did some research in the area of PSA testing and prostate cancer, so this field is a personal interest of mine. My impression from reading the NY Times article, The Great Prostate Mistake, by the pathologist who discovered the test, is that questions being asked in the nineties are being answered more and more in the negative.
In the large study I worked on, we found that lowering the threshold level of PSA deemed worrisome in younger men resulted in more positive biopsies, including biopsies with apparently significant higher grade/aggressive cancer, but whether or not treating those cancer had overall beneficial results wasn’t known or determined. This illustrates a common dilemma in medical science – what happens when detection methods advance before sufficient evidence exists as to the risks and rewards of potential treatment options? The goal shouldn’t be to simply find cancer, but to promote a healthful life. The words "do no harm" are particularly meaningful. With that, let’s move on to the thoughts of John Wrenn MD, a practicing urologist who sent me the NY Times article along with his thoughts on the subject. - Ilene
My Take On The Prostate
Courtesy of John Wrenn, MD
As a urologist, I make a lot of my living off of prostate health and certainly have concerns about over testing, over diagnosis and over treatment. The biggest question remains, in my opinion, who to treat more than anything else. I think PSA screening is probably on par with Mammograms and cholesterol testing as far as questionable value is concerned. Colonoscopy doesn’t seem as dubious largely because colon cancer tends to have fewer gray areas as to who needs treatment, and while invasive, screening for colon cancer doesn’t lead a significant portion of patients with positive findings to treatments that only make a difference in cancer specific survival for a few, while causing life altering functional changes in many.
I am still not sure that America is ready to return to a medical system where treatment is only given when the disease becomes symptomatic or grossly detectible, although the outcomes would probably be only marginally different…