PSA test: Don't do it, say angry men
There were groans in the audience, knowing nods of the head, a good number of men leaving auditorium seats in a rush to the bathroom, and wives giving a comforting rubs to their spouses' arms at each intimate revelation in the documentary they were watching, "The Second Opinion." Many of these men, guests invited by a fledgling group trying to get the word out that they think the standard screening test for prostate cancer is a bad idea, had more than a casual interest in prostate cancer. They've lived through its impossible choices and the often mutilating results of its treatment. Some of them were as sad, frustrated and angry as the men on the screen.
Now, a recommendation in the Aug. 5 Annals of Internal Medicine might give a boost to this start-up organization, Cure for Prostate Cancer Now Foundation. (Don't Google it. It doesn't have a website yet, and you'll get organizations that have the exact opposite agenda.) The U.S. Preventive Services Task Force, which in a 2002 recommendation failed to take sides for or against PSA tests for men, saying there was insufficient evidence that early detection improves health outcomes, has gotten a bit stronger.
In its 2008 recommendation, the task force comes flat-out against the test for men older than 75.
That should make Richard Ablin happy. He's the guy who discovered the protein PSA in the first place, back in 1970. The research professor at the University of Arizona Health Sciences Center has spent 38 years arguing that using PSA levels as a marker to screen for prostate cancer is a worthless endeavor, with potentially mutilating effects on men scared into following the test with surgery or radiation. "The PSA test is an absolute, total catastrophe," Ablin said after the screening.
The movie last month at the Gower Theatre at Paramount Studios showed men discussing embarrassing and humiliating consequences of treatment for prostate cancer. Some in the film talked of wearing diapers. One man hadn't had an erection in 13 years. "Being impotent for 13 years bothers me no end," he says in the movie. One man in the film, a vigorous 78-year-old when he opted for cryosurgery, in which cancer cells are killed by freezing the prostate gland, was now an 80-year-old barely able to walk, and unable to normally empty his bladder or have sex after numerous surgeries to correct damage to surrounding organs, accidentally frozen during the procedure.
And the several hundred men in the audience, some with their wives, nodded, perhaps in silent understanding. They may be among the 234,000 men diagnosed each year with prostate cancer. About 150,000 of those diagnosed move quickly to choose surgery or some form of radiation treatment. Only about 12% choose to wait it out and be medically monitored for signs of worsening, according to a story in the July 3, 2006, Los Angeles Times.
The dilemma for men diagnosed with the PSA test is that it often steers far too many men to treatment that can result in impotence and incontinence.
Unfortunately, there's no way you can see the movie. Not yet. The moviemakers and organizers of the event are just getting started in fighting back against a national movement to promote the PSA test for men over 50. They are searching for a distributor for the documentary.
Los Angeles urologist Dr. Alan Shapiro says in the movie, "The PSA test has done much more harm than good." That's because men are rushed to treatment, either surgery to remove the prostate or radiation to kill the cancer cells. Both treatments often result in a man's inability to have an erection or an orgasm and in lifelong incontinence. "Ask me what my PSA number is," Shapiro says after the screening. "I don't know. I practice what I preach." That's because the odds are high that the cancer cells discovered by the test will never do any harm. Most men will go on to live long, healthy lives and eventually die of something else.
The odds are also good that those who opt for surgery or radiation will survive and be cured of their disease. The problem is that no one knows how many of those treated never needed to be cured of anything. Their disease would not have progressed. Thousands of them will have suffered severe consequences for no good reason, but they'll never know.
Of the 232,000 men diagnosed with prostate cancer each year, the vast majority have a slow-growing kind that will never escape the prostate or cause any noticeable problem. Still, 32,000 men die each year of the disease after their cancer spread from the prostate. But testing cannot accurately sort the deadly cancers from the harmless cells.
It adds up to many men receiving emasculating therapy when medical science cannot say definitively that they need it. The documentary screening, says Shapiro, was timed to counteract all the public service announcements seen on Father's Day urging men to take the PSA test to be screened for prostate cancer.
The test gained FDA approval after Dr. Thomas Stamey published the first paper in 1987 in the New England Journal of Medicine claiming that it could be used to diagnose early prostate cancer. He's come full circle, and no longer supports the test as a screening tool, saying "The PSA era is over in the United States."
The debate isn't over. The American Cancer Society recommends PSA screening, along with a digital rectal exam, for men over age 50. But the American Medical Assn. says that PSA screening is unwarranted. Now the U.S. Preventive Services Task force says there's not enough evidence to warrant doing it, and those over 75 should not have the test.
And a new group, still website-less and in search of funding to distribute its documentary message, is joining the fight against the screening test.
-- Susan Brink
Illustration: Wes Bausmith, Los Angeles Times