Prostate cancer screening has always been controversial.
Now, with the USPSTF is recommending against screening for prostate cancer, gas is about to be poured on the proverbial fire.
Recently, the New York Times Magazine published a lengthy piece on the issue, perhaps not coincidentally, perfectly timed with the Task Force’s announcement.
In 2009, advocates for breast cancer screening were up in arms, with the Task Force recommending that mammograms for women between the ages of 40 and 49 were optional, and decision individually made between patients and providers.
This time, the recommendation against prostate cancer screening is more forceful, and is bound to not only be politicized, but attacked by specialists and prostate cancer survivors.
Prostate cancer screening is most commonly performed by a blood test testing for the prostate specific antigen, or PSA. But the test is not without its risks:
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, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a “public health disaster.”
I wrote in the New York Times earlier this year that Medicare should stop paying for PSA screening in men over the age of 75, mainly because PSA isn’t good enough to detect which prostate cancers are dangerous, or not. There is no conclusive data showing PSA saves lives.
But statistics don’t resonate. In fact, prostate cancer screening supporters are already lining up in force to tell their inspiring stories of prostate cancer survival:
Advocates for those with prostate cancer promised to fight the recommendation. Baseball’s Joe Torre, the financier Michael Milken and Rudolph W. Giuliani, the former New York City mayor, are among tens of thousands of men who believe a P.S.A. test saved their lives.
To combat this, Task Force advocates will need to put a human face on the complications stemming from prostate cancer. Something like this:
[National Cancer Institute researcher Otis] Brawley tells the story of a patient who had surgery and then underwent radiation, which left him with severe damage to both his rectum and ureter. “He had every side effect known to man,” Brawley says. “He had a bag for urine, a bag for stool, he was a terrible mess, in and out of the hospital with infections.” The man died six years after his surgery, from an overwhelming infection. Yet cancer statistics would list such a man as a success story, Brawley says, “because he survived past the five-year mark.” Would an untreated prostate cancer have killed him within six years, too? There is simply no way to know.
Politicians and celebrities will use their poignant stories to powerfully attack the recommendations. Evidence-based supporters will need more than cold terms like “number needed to treat” and “absolute risk reduction.”
Without stories of their own, the Task Force recommendations will be vilified in the arena of public opinion, despite having the studies on their side. In today’s health care environment, emotion trumps data.