Recently, the United States Preventive Services Task Force made a recommendation that healthy men should no longer receive the prostate-specific antigen (PSA) test for prostate cancer, the most widely used and most effective test for the second-leading cause of cancer death in men.
They came to their conclusion after reviewing many studies and concluding that the odds of dying from prostate cancer stay about the same regardless of whether the cancer is detected by PSA screening. In fact, one European study they cited showed that men who had the PSA test found a statistically insignificant (0.06 per cent) absolute reduction in prostate cancer deaths for men aged 50 to 74 years. But this same study also shows that PSA-based screening "corresponds to a relative reduction of 20 per cent in the rate of death from prostate cancer among men between the ages of 55 and 69 years at study entry."
However new evidence suggests that measuring your PSA beginning at age 40 as a baseline and tracking it over time, a tactic known as PSA velocity, shows promise of leading to a more accurate diagnosis of early stage prostate cancer, especially when correlated with age, ethnicity, family history, physical examination and symptoms.
But with this latest salvo against one of our most basic and inexpensive cancer tests, the PSA, we are unlikely to see any large-scale trial of a more sophisticated and comprehensive screening strategy.
So what to make of this? From my vantage point as someone in the industry, let me try and boil down what the task force really is saying: Don't worry, be happy and oblivious. Because sometimes we're wrong and think you have prostate cancer when you don't. Because the treatment's after-effects can be rough. Don't worry, be happy, do nothing -- even though many of us know someone who has died young from prostate cancer.
Bear in mind, this same task force and other distinguished academics provided similar advice to women recently when they suggested that getting a mammogram before the age of 50 was a waste of time for some. While the mammogram undoubtedly saved some lives, I believe it needlessly caused worry or unnecessary procedures in women who either had slow-growing breast tumors, or benign tumors that were unnecessarily biopsied.
This style of advice isn't new. A paternalistic streak exists in some parts of the medical profession, in particular by those retained by government to save the system money. I think they don't want you "worrying" about information you can't understand lest you actually ask your doctor to do something about it. They practice population medicine, not patient medicine. And they fail to appreciate that patients are becoming increasingly knowledgeable and informed and just might be able to handle the weight of knowing their PSA score -- or that they have a breast tumor that in all likelihood won't kill them.
So far as the PSA goes? It's not perfect, but as one urologist friend of mine insists, it is helpful, particularly when used in concert with other variables that assess risk. And in general, prostate cancer is not one of those cancers you need to die from, provided it is caught early enough. So let's not run away from information. Embrace it. Study it. Rather than taking steps to keep patients ignorant about important aspects of their own health, we should be empowering patients by encouraging them to do their own research, to provide them with the tools they require to make informed decisions about their own care. My own father, a physician, had prostate cancer discovered by his PSA. He had his prostate removed by one of the world's leading urologists. We didn't leave it to a government task force to decide for us.
Shaun Francis is chairman and CEO of Medcan, North America's largest preventive health clinic and one of Canada's 50 Best Managed Companies.