Prostate Cancer Screenings Stir Debate

A panel of doctors reports that the tests are doing healthy men more harm than good. But what is the right choice for Black men, who are more than twice as likely to die from prostate cancer?

Posted: 10/18/2011 06:14 PM EDT
Filed Under public health

By analyzing the date from five clinical trials, the United States Preventive Services Task Force believes that the P.S.A. test — a test widely used to assess prostate health in men — does not really predict cancer and often leads to additional tests and treatments that needlessly cause pain and impotence in many healthy men.


The New York Times reported:


The P.S.A. test, routinely given to men 50 and older, measures a protein — prostate-specific antigen — that is released by prostate cells, and there is little doubt that it helps identify the presence of cancerous cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men who do have fast-growing cancer, the P.S.A. test may not save them since there is no proven benefit to earlier treatment of such invasive disease.


As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, Richard J. Ablin, who in 1970 discovered a prostate-specific antigen, has called its widespread use a “public health disaster.


But the task force is clear: These recommendations are only for healthy men without symptoms.


And while there are doctors who support these recommendations, there are many who don't and wonder how men with higher prostate death rates, such as African-American men, who are 2.5 times more likely to die from prostate cancer, will be impacted by these findings.


Recently, NPR's Michel Martin interviewed  two black doctors — Compton Benjamin, a urologist at George Washington University, and Otis Brawley, from the American Cancer Society — to probe the subject.


Dr. Brawley said that he agrees with the task force's recommendations and believes that while he doesn’t oppose the test itself, he believes it’s overused and that its benefits are exaggerated. "We started using it, by the way, before we started doing the studies to actually see if the thing saves lives, and that's a real problem with medicine,” Dr. Brawley said. “That's something we in medicine frequently do. We get out ahead of the curve, and we end up sometimes hurting people by doing things that we think are right, and 15, 20 years later find out are not right, as is the case with P.S.A. now.”


For his part, Dr. Benjamin stressed that for the African-American community, which is already less aware about prostate cancer, these recommendations could further push this issue into the closet.


“I say that I myself will continue to be screened,” Dr. Benjamin said. “I have a family history of prostate cancer. I am an African-American, and despite the risks of problems with the surgery — I think that being there, to be for my kids as they grow up, is important to me."


Where do you stand on this issue?


To learn more about prostate cancer, go here.

(Photo: The Washington Times/Landov)

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