Monday, May 4, 2015

To Psa or not to Psa.




   I read a tweet the other day regarding prostate cancer and breast cancer screening. The jest of the tweet was that screening is resulting in over treatment. It states that screening for prostate cancer is no longer recommended. I have a friend. A very good friend I might add. He is a fellow PCa survivor. He is cured. He caught the disease early enough that with a little luck and a great doctor he beat up the disease and stole its lunch money. I have no idea how the disease was discovered but I assume it was a PSA test. My friend is on the side of not screening men for Prostate Cancer. He sides with the opinion of the medical community that too many men are being treated for cancer that would never impact their lives but are now suffering with side affects of unneeded treatment. To be fair, my friend is also on the side that says we need a better test that can determine aggressive cancer from cancer that is slow growing and of the temperament that a man will die with it and not of it. I agree with my friend on that point but we don't have that kind of test yet.

   My friend was diagnosed the same year as I. Although the cancer was advanced it was still localized to the area of the prostate. He did what most people do when they hear the "C" word. He wanted it gone. He had a prostectomy followed by radiation followed by a 3 year stint on hormones. 8 years later he is cured. I am happy for him. He is my brother. He and his family deserve the very best. I disagree with his opinion however.

   I agree that there a many men who have nothing to fear from a prostate cancer diagnosis. I realize that a lot of guys panic over non aggressive G-6 cancer and pull the trigger on surgery when it is not necessary and quite often have problems for years afterward and sometimes permanently. I understand all of that but I simply don't care. Men deserve the right to make a decision about their own health. If a g6 guy decides to have surgery that isn't needed then so be it. It's on him. Not screening most likely won't affect those guys.Not screening affects guys like me. Had my friend not been screened he would be in the same boat as I am.
   I was stage 4 at diagnosis. I was 42 at the time. I may have been diagnosed early enough to be cured if screening had taken place at age 40. 
   What are the facts. Men in the United States stand a 3% chance of dying from PCa. Screening lowers that risk by 20% or to around 2.4%. PSA screening increases the chances of a man eventually facing a prostate cancer diagnosis by 70% or from 10% to roughly 17%. Considering the majority of prostate cancer is slow growing and does not spread, it is easy to see why screening is getting a lot of negative publicity lately. There are way too many men who spend the rest of their lives dealing with incontinence and sexual frustration who might have never known they had prostate cancer until after they passed away of natural causes if they had never been screened. " The needs of the many outweigh the needs of the few"(Spock) 
   More like "the few" fall through the cracks because statistically the majority of prostate cancer is indolent. Here is another fact. 25,000 American men die of prostate cancer each year. 20 years ago the number was more like 50,000

   The choice of being screened should never be decided by a doctor or an insurance company. The decision to be screened should be by the individual. 
People can say what they want but there is one indesputable fact that tends to be overlooked in the debate. Since FDA approval of PSA testing less men are dying from Prostate Cancer.
   I agree that many men are being treated that shouldn't be. I agree that we need a way to determine whether cancer is aggressive or indolent. In fact I agree with many of the talking points that validate the over screening controversy. The problem is we don't have another test. We don't have a way of determining whether or not a man should be treated. We cannot place everyman into a cookie-cutter mold and say this works for everybody. It doesn't work for everybody. 
   Urologists make money doing Prostectomies. Hospitals make money on the surgeries as well. I was never afforded the luxury of options but I wonder what percentage of surgeons recommend watchful waiting upon a diagnosis of prostate cancer.
   We need education. We need empowered men making decisions regarding their health without doctors or insurance companies quibbling over cost vs. risk. Today we have the PSA test and until something better comes along it is an important tool that since 1992 has saved thousands of lives. We don't go back to the days of stage 4 cancer diagnosis being the norm. We don't throw the baby out with the bath water. We don't stop using the only screening mechanism we have until we have something to take its place. I camp firmly in the "To PSA" side of the debate.