Just Say No to PSA

So, the US Preventive Services Task Force recently released a recommendation that we stop using the PSA test to screen for prostate cancer in most cases.  I wrote way back when in a mini-post:

1) We so over-screen for Prostate cancer.  Unless things really change, no PSA test for me.  The costs so clearly outweigh the benefits but everyone is irrationally (though understandably) afraid of cancer.

Glad to see the medical establishment has now come to the same conclusion (of course, Republicans can now argue that this is about “death panels”).   I wanted to write something about this, but didn’t come across any articles that really grabbed my attention.  Alas, yesterday, I found this fabulous piece from a recent NYT magazine that really lays it all out.  Among other authors, it is by Shannon Brownlee, who wrote the terrific book, Overtreated: How Too Much Medicine is Making us Sicker and Poorer (I gave it 3 1/2 of 4 stars back when I read it).  Anyway, I think this extended analogy/metaphor from the piece makes the case brilliantly:

“Imagine you are one of 100 men in a room,” he says. “Seventeen of you will be diagnosed with prostate cancer, and three are destined to die from it. But nobody knows which ones.” Now imagine there is a man wearing a white coat on the other side of the door. In his hand are 17 pills, one of which will save the life of one of the men with prostate cancer. “You’d probably want to invite him into the room to deliver the pill, wouldn’t you?” Newman says.

Statistics for the effects of P.S.A. testing are often represented this way — only in terms of possible benefit. But Newman says that to completely convey the P.S.A. screening story, you have to extend the metaphor. After handing out the pills, the man in the white coat randomly shoots one of the 17 men dead. Then he shoots 10 more in the groin, leaving them impotent or incontinent.

Wow– that’s a pretty obvious and stark choice.  And it represents quite well the actual consequences of PSA treatment and screening as currently used.  Furthermore, there’s the opportunity cost of being so wedded to an approach that is so ineffective:

For Brawley, the greatest tragedy of P.S.A. screening is that it has been a distraction from making greater progress in reducing deaths with the one clear helpful thing: distinguishing between the prostate tumors that really need to come out and those that are better left alone. Instead, new types of P.S.A. screening are being promoted.

If you are a man over 40 and you are reading this, there’s quite a decent chance you actually have cancer in your prostate:

The current thinking is that about 30 percent of men in their 40s have prostate cancer, 40 percent of men in their 50s and so on, right up to 70 percent of men in their 80s. Yet only 3 percent of all men die from the disease. In other words, far more men die with prostate cancer than from it, and only a tiny fraction of prostate cancers ever cause symptoms, much less death.

Just accept it.  There’s a very small chance it will actually kill you.

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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