A PSA About PSA

There have already been nine Presidential debates, and another 14 are tentatively scheduled before next August’s Republican National Convention in Florida. After that, we have the myriad of debates between President Obama and the Republican candidate in the run up to the 2012 election.

For a regular commentator like myself, even one who narrowly focuses on issues of health and science, such debates are both a blessing and a curse. They give me a lot of fodder to write about, but the platitudes and half-truths spouted by the candidates also infuriate me. I often find myself turning off the television or leaving the room after a particularly egregious and self-serving statement.

The recent debate in New Hampshire was no exception. When asked a rather straightforward question about what he would do to rein in wasteful Medicare spending, former Speaker of the House Newt Gingrich sidestepped the question completely.
Instead, he used the opportunity to attack a recent report by the US Preventive Services Task Force that questioned the usefulness of a routine blood test used to screen men for prostate cancer. At that point, I started yelling at the TV.

There were a number of reasons why I got upset. First, Gingrich used this example primarily to resurrect the debunked claim that the US government is creating bureaucratic “death panels” to decide who receives medical care. All politically motivated fear-mongering aside, the US Preventive Services Task Force is actually an independent and non-partisan group of healthcare experts that draft non-binding recommendations about the benefits and risks of primary care and prevention services.

Furthermore, in condemning the Task Force’s report, Gingrich supported his claims by citing the views of Dr. Andrew von Eschenbach, former head of both the National Cancer Institute and the Food and Drug Administration. But Dr. von Eschenbach is also a board member and scientific adviser of the Prostate Cancer Foundation and a Senior Fellow at the Milken Institute, both founded by disgraced financier Michael Milken. Milken is also a cancer survivor whose illness was detected by the very test the Task Force is now questioning.

Prostate cancer is indeed a serious problem. In the US, about a quarter-of-a-million men are diagnosed with prostate cancer every year. Nearly 30,000 Americans die annually from the disease (including one of my former mentors at Berkeley).

For nearly two decades, a rather simple and non-invasive blood test known as the Prostate Specific Antigen (or PSA) assay has been the primary tool used to screen men for prostate cancer.  About 20 million PSA tests are performed each year, mostly on otherwise healthy men without a family history of prostate cancer. Many of these men don’t even realize they are being tested for cancer.

Of the millions of tests performed annually, about 1-in-20 come back positive. A positive test may be indicative of cancer, but usually is not. Nevertheless, men with a positive PSA test are referred for additional testing and, if necessary, treatment.

While the PSA test itself is non-invasive, the confirmatory tests aren’t. The only way to determine if a man has prostate cancer is a biopsy through the rectum, a procedure that causes infection and urinary problems in many who undergo it.

It also turns out that the vast majority of men with prostate cancer will never be harmed by the disease. Nearly one-third of middle-aged and three-fourths of elderly men have detectable prostate cancer, but most do not and will not have any outward signs or symptoms of disease.

Most men can live long and comfortable lives with prostate cancer. What most cannot do is live with the knowledge that they have the disease. Once you tell someone they have prostate cancer, they will likely insist on treatment. Unfortunately, current treatments kill or maim about 5% of patients and leave another 25% impotent or incontinent.

Some lives have been saved by early detection of prostate cancer using the PSA test, including the lives of such outspoken (and sometimes controversial) celebrities as Michael Milken and Rudy Giuliani. However, many studies suggest that routine screening has no overall impact on rates of death due to prostate cancer. One study even found that for every life saved by a routine PSA test, almost 25 men will suffer life-long and debilitating side-effects from unnecessary treatment.

This is why the inventor of the PSA test himself, Dr. Richard Ablin, called its widespread use “a public health disaster.” The test, he argued, should be used to monitor men after treatment or to screen men with a family history of prostate cancer. It should not be used for routine testing.

The controversy about the Task Force’s recommendation is not likely to go away anytime soon, and many doctors still believe in the usefulness of the test. But the debate over routine screening is best left to the medical experts. It is not something that should be used by ill-informed politicians as a talking point during a debate.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on October 27, 2011. It is also available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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One Response to A PSA About PSA

  1. Talk is cheap and I so dislike that we live in times marked by such a remarkable lack of critical thinking. I read a piece recently in the NYT about the shocking number of people who have stopped believing in man-made climate change impact. If I hear Rick Perry call it “junk science” one more time, I will have to jump off the edge of the flat earth or something. (ahem, excuse me, he would be able to “prove” that junk science assertion how? Grumble.)

    So many Americans, in this era of too-much-information-too-little-thinking just grab the words of whatever pundit or politician or preacher who appeals to them and they run. At my workplace, thanks to the email/website leanings of my predecessor, I receive all kinds of stupendously stupid messages in the office email box. One does not need an advanced degree in science or a visit to snopes.com to see what is purely junk-email!

    Gingrich is unconscionable to me in a very different way – he actually does possess intellect; he just chooses to use it to bad ends.

    And in the end, be it prostate cancer or something else, life is not valued by the crowd who seems to shout that line the most.

    (OK, sorry for the rant so early in the day!!)

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