Prostate cancer detection method now in question

The U.S Preventive Services Task Force (USPSTF), a panel of independent experts dedicated to evaluating scientific studies on new treatments, recommended that healthy men should avoid regular PSA (prostate-specific antigen) testing, a common screening test for prostate cancer in men. The USPSTF concluded from scientific studies that PSA testing does not lower the death rate of prostate cancer, due to the post-surgical complications that lead to death of men with even benign tumors.

Prostate cancer is the second leading cause of cancer death among men, following lung cancer. It originates in the prostate gland, a walnut-sized gland involved in the male reproductive system. Most tumors detected by the PSA tests are benign, while a small fraction of these tumors metastasizes and kills the patient.

PSA testing, as the name suggests, determines the amount of prostate-specific antigens in the blood. Although it is typical for men to have low PSA levels, men with prostate cancer, both malignant and benign, tend to have increased PSA levels. Using this information, physicians can discuss treatment options with patients.

This mainstream method of diagnosing prostate cancer can be largely attributed to the advocacy by William Catalona. During his residency training at Hopkins Hospital in the mid-1970s, he opened a clinic for late-stage prostate cancer patients, whose only option for finding the tumor was by a direct rectal examination. By the time the tumor could be felt along the rectal wall, it was typically too advanced to offer a reliable cure. Passionate towards his patients' health and quality of life, Catalona conducted a study with a large patient population and discovered that patients with prostate cancer had high PSA levels, leading to the popularity of PSA testing.

Against the interest of the many patients and physicians reliant on this test, the USPSTF drafted a recommendation to discourage it. This recommendation is only intended for healthy men who do not pose symptoms that indicate cancer. The task force, and other professors and agencies that approve this recommendation, became target to a torrent of dissidence, backed by current survivors of prostate cancer and affiliations belonging to the multi-billion dollar industry that has come to provide treatments for these cancer patients.

Dissidents of the new recommendation to avoid regular PSA stated that the PSA tests could reduce a man's chance of dying of prostate cancer by diagnosing it earlier.

On the other end of the radically polarized views, some say that conducting these tests on men who have no symptoms can reveal indolent cancers, unnecessarily intimidating men into agreeing to undergo risky surgery on the benign tumors. Up to one in 200 men die within a month from complications due to these surgeries. Ultimately, the PSA tests do not lower the death rate of prostate cancer patients.

Our view of cancer is still tinged with fear of inescapable suffering — up until recently, cancer had not been diagnosed until it was causing physical symptoms, and thus was not treated in time. Currently, it has become possible to screen for cancer before its advanced stages, but it is difficult for patients to fathom being left untreated, despite the possibility of the tumor being benign.

To adapt the metaphor proposed by David Newman, a director of clinical research at Mount Sinai School of Medicine in Manhattan: Imagine a room of 100 men. 17 of those men will be diagnosed with prostate cancer, and three are destined to die from it. Now imagine a man wearing a white coat with 17 pills, which can cure the cancer. Most of the people in the room will want to take a pill from the doctor. However, one of the pills, statistically, will kill the man who consumes it, and 10 other of these pills will leave a man impotent or incontinent. Now, will you take the pill?

The opposing narratives have boiled down to how a patient can be harmed: from the cancer itself or the collateral damage from treatment. There is a definite need of spreading the awareness of downstream events for men who may potentially have prostate cancer. For now, the USPSTF is telling healthy men to avoid testing when there is no need for it.