It’s interesting to reflect on the recent USPTF PSA upheaval – and to consider how and why we are here from a position of compassion.
Personally, I’m interested and involved because my dad died of aggressive prostate cancer. He was screening – back in 1996 when screening was gaining momentum as a tool to find cancer early. The antiquated PSA threshold for a man of his age during that time period missed his cancer. He was in his late 40s (with a PSA of just under 4). His cancer was found several years later… only then it was too late for him.
Modern standards for PSA might have saved his life. Due to the nature of long-term data collection, the data considered by the USPTF simply can’t consider PSA use based on modern standards. So while screening may have saved my dad’s life had his results been considered using modern standards (such as age and race adjusted PSA or PSA velocity), his case is seen as a screening failure.
Another important consideration is how the PSA was pushed to market. Addressing prostate cancer is not JUST about the tests used to find cancer. In order for screening to yield maximum personal benefit, it must be considered as part of the big picture of men’s health. The disease grows relatively slowly when compared to other cancers, so knowledge about other co-morbidities such as heart disease and diabetes is extremely important in making sure the man lives a good long healthy life. A man who has his prostate cancer cured only to drop dead two years later of a heart attack probably did not benefit from treatment – eg, he was “over treated,” and usually irrespective of how aggressive his cancer was. Preventing other major causes of mortality in men is often as important as finding cancer early.
On top of this, men are often drawn to screening programs by the use of “scare tactics.” A man who shows up to get screened because he is afraid if he doesn’t he is going to die of prostate cancer is primed for really bad decision making should he ultimately be diagnosed with prostate cancer. Sometimes, maybe even often, the only factor guiding treatment choice is fear. Attempts to justify using fear to motivate any and all decision making often apply the “at least he’s alive” rationale. This statement is often inaccurate and boldly insensitive… who can ignore the clear issues of over treatment and the sometimes devastating impact treatment can have on a man’s quality of life? To shrug off unnecessary suffering in any form is abominable – and the FACT that the tools are there to understand disease aggressiveness and manage side-effects – and often disregarded with the “tough it out” response of “at least your alive” is ridiculous…
A more accurate and humane approach to awareness might involve supporting the man who decides to screen as part of a bigger plan to take charge of his health. This might go a long way towards addressing the underlying issues that challenge our efforts to reduce prostate cancer cancer death and effectively address the disease.
As I light my blue light for this year’s Men’s Health Night (Monday, November 21, 2011), I do so for all of the men who have lost their live’s -and quality of life- in the name of ignorance and inhumanity.
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