PSA Tests vs. a Poke in the...

Very publicly, Ben Stiller wrote last week about how a PSA test probably saved his life.  On the surface it seems like a no-brainer to get a PSA test every year much like it would be for a woman to get a mammogram every year after a certain age.

However, recommended test frequencies have changed for both tests and in the wrong direction, in my opinion.  The logic appears to be similar to both tests in that very early detection can lead to surgical solutions when less drastic (and less costly) solutions might suffice.  These procedures can have possible adverse side effects which, arguably, could have been avoided.  I can completely understand why there is an increase in cancer surgeries.   The "C" word still generates a knee-jerk fear that often leads people to say, as some of my friends have said, "Just cut the damn thing out."

The reality, at least with prostate cancer, is that it usually has a very slow growth rate and early detection does not show a significant positive impact on the survival rate.  According to the American Cancer Society, the 5 year survival rates (the typical bench mark for all types of cancer) are:

• The 5-year relative survival rate is almost 100%
• The 10-year relative survival rate is 98%
• The 15-year relative survival rate is 95%

I don't know the statistics for all types of cancer.  But this seems about as good as it gets.   And these statistics were based on the traditional, annual PSA and other prostate examinations.  

But the other statistics from ACS about prostate cancer are sobering:

• Prostate cancer is the 2nd most common cancer for American men (behind skin cancer)

• 1 in 7 men in the U.S. will be diagnosed with prostate cancer during their lives

• Prostate cancer is the 2nd leading cause of cancer deaths in men (behind lung cancer)

So, as a layperson, I simply can not see the logic of preventing the earliest possible diagnosis of cancer. If the recommendations to lower the frequency PSA and prostate cancer are designed to reduce the costs and the potential complications of unnecessary procedures, then, perhaps, I think it's up to physician's to help patients developed a reasoned response to a diagnosis of prostate cancer.