My prostate is featured in the AARP Bulletin!

Great blog post title, if I say so myself. Which, naturally, I did, this being my blog. It's even accurate!

Exclamation marks are sprouting because I'm excited about being quoted in the November 2012 AARP Bulletin story,"To Test or Not to Test?," about whether men should get a PSA test that screens for prostate cancer.

The article by Chris Woolston is well worth reading in its entirety. But if you're only interested in the good parts, a.k.a. the paragraphs where my name is mentioned, I'll make it easy for you.

Like millions of American men, Brian Hines, 64, has a yearly ritual. Every fall, the Salem, Ore., resident has his blood checked for PSA (prostate-specific antigen), a protein that can be an early warning sign of prostate cancer. So far his numbers have always been low, generally a sign that his prostate is healthy and cancer-free.

But now, Hines says he might skip the test because it may do nothing more than "buy you a ticket for the treatment merry-go-round."

...The benefits of PSA tests may be murky, but the risks are undeniable. Brian Hines is right: A positive PSA test can be a ticket to treatment. It often starts with a needle biopsy, a procedure in which a doctor inserts a needle -- usually through the wall of the rectum -- to remove tissue samples from the prostate. The procedure is uncomfortable and can cause bleeding and infection. If the biopsy confirms cancer, the next step is often radiation or surgical removal of the prostate, a serious operation that can leave a man facing impotence, incontinence, or both.

Yikes.

Now I'm really leaning toward not getting a PSA test at my annual physical, which is coming up next week. Last year I blogged about deciding to get the test even after hearing that the United States Preventive Services Task Force had recommended against it, in most cases.

Woolston read that post, then interviewed me by phone about my personal to test or not to test? feelings.

I told him that if a man has a good family physician, like I do, who will discuss with him the consequences of follow-up diagnosis/treatment if a PSA test is elevated, and not pressure him into getting on that "treatment merry-go-round," then there seems to be little harm in getting a PSA test.

After all, the vast majority of PSA tests are negative.

So the likelihood is that a man will be reassured by a test that he doesn't have prostate cancer. Is that reassurance worth the anxiety of getting a positive PSA test result? Or the prospect of impotence and/or incontinence if, somehow, he finds himself on that treatment merry-go-round?

Talking with Woolston, I tried out the argument that I shared in my 2011 blog post.

In the exam room I told my doctor, "The main argument against getting a PSA test seems to be that a positive result often leads to unnecessary treatment, with nasty side effects (impotence, incontinence). However, this implies that patients are helpless to resist the Medical Treatment Machine, which sucks them in against their will."

So I thought, why not? 

A positive test result would worry me, but not nearly so much as it would have before I learned that 80% of positive PSA results are false. Thus usually it makes sense to take a positive result lightly, or even to ignore it completely.

Again, I realized that I could either ignore the PSA test by not getting one, or I could get the test and then ignore the results. (Which turned out to be negative, by the way.) I trusted that my doctor and I could deal with a positive result wisely -- not rushing into a biopsy or surgery without a very good reason.

Makes sense.

However, after reading the AARP Bulletin article, I'm now strongly leaning toward not getting the test when my doctor asks me about it next week. If solid research shows that the benefits of the PSA test aren't worth the costs (not monetary, but health-related), then what's the point in having the test done?

Ignorance can be bliss, since the article points out that "97 percent of men die from something other than prostate cancer, which means any given man is far more likely to die with the disease than from it." This seems to be an instance where treatment is worse than the disease. 

Not always, of course, but generally.

Each man has to weigh for himself the pros and cons of getting a PSA test, along with his/her doctor. I feel good that I was able to help educate the 22 million or so potential readers of the AARP Bulletin about this difficult decision. 

Cancer is shitty. But so is getting unnecessary diagnostic tests and treatment with nasty side effects. 

Comments

[Frank Haynes]

Brian, this is interesting to me because I had a "positive" PSA test a couple of years ago. My brother had told me he had a positive test result prior to mine, a year or so before, and told me of the biopsy in gruesome detail. When my doctor informed me of elevated levels compared to prior test he said he would recommend me to a specialist. I asked if that meant needle biopsy and he said yes. I informed him that my brother had told me what that entails and that I would die before having to go through that! I had also read about the abnormally high false positives found in PSA tests, so discovered (on the internet) a couple of causes for false positives and implemented them such that the next test was back to normal again!