Last week’s news that the U.S. Preventive Services Task Force now recommends that men should not get a prostate specific antigen (PSA) test has been a hard pill for many men to swallow, at least judging by the flood of outraged responses from prostate cancer survivors who believe that getting a PSA test saved their lives. As one fellow put it, “If not for the PSA tests, today I would be dead and buried.” That pretty much sums up comment after comment left on stories about the task force’s new recommendation, including one I co-authored.
It’s not hard to understand why men who have been tested and treated for prostate cancer might feel this way. We’ve been told for years that early detection leads to cures. That’s the mantra of the American Urological Association, the group that represents physicians who often treat prostate cancer. Until very recently, the American Cancer Society also urged men to get tested in order to avoid being killed by prostate cancer. Then there are the prostate cancer awareness groups, many of which have promoted PSA testing relentlessly with slogans like, “Man Up,” and “Know Your [PSA] Number.”
And for some men, the PSA test does deserve credit for catching a potentially deadly cancer early enough to be treated successfully. The trouble is most men who get treated didn’t have a cancer that needed treating. So while a given man may believe fervently that early treatment saved his life, there’s a better than even chance that he would have been fine even if his cancer had been left well enough alone.
(MORE: The Screening Dilemma)
Such nuance gets lost in all the heart-felt testimonials from brave men who “manned up,” who got that PSA test and beat their cancer. These stories fit neatly into our heroic narrative of medicine, the one in which we wage war on cancer and win (maybe in contrast to some of our battles on the ground in the Middle East). Every man who tells his success story to a friend, online, in a cancer support group confirms the American can-do spirit and makes us feel good about all the progress we’ve made against prostate cancer.
But the happy talk only tells half the story. We never hear from the men who died from their prostate cancer treatment or biopsy. And there have been plenty of them. The mortality rate during or shortly after prostate surgery is estimated to be 1 in 200, according to a study published in the Journal of the National Cancer Institute. We also don’t hear much from the men who are suffering from incontinence, impotence, or both, the devastatingly common side effects of treatment.
If blog comments were representative of reality, a lot more of the stories about PSA testing would sound like this man’s:
“I had a PSA test . . . I had a biopsy, and they found cancer. My doctor said I should have a prostatectomy, and I did. The surgeon did everything right, but I have problems getting erections and controlling my bladder at night. Now my doctor is telling me that I might never have had a problem with the cancer, even if I never got treatment.”
It’s no surprise that men don’t tell these sorts of tale very often. They have enough trouble talking to their doctors about impotence and incontinence, much less the whole world. There may also be another reason we don’t hear from these men. To acknowledge being harmed by the treatment also means a man may have made a terrible mistake. He chose to be treated, and now he may be suffering for no good reason from life-altering side effects.
If we’re ever going to have a clear view of PSA testing, maybe we need to hear a little less from the warmongers — the screening advocates — and a little more from the men who have been hit by the collateral damage that our war on prostate cancer in leaving in its wake.