When my family doctor called five years ago with the news that my PSA levels had spiked, I hung up the phone and did what all of us do. I panicked. I thought, "So this is how I'm going to die."
Then came the delayed second reaction: This can't be right! I'm a teetotaling, nonsmoking, very fit middle-aged baby boomer, a husband and a father of a 13-year-old daughter. This just wasn't in the Tarot cards.
Fortunately, I have five or six very close doctor friends, so I called one of them right away. He sent me to the bathroom.
"Look in the mirror and tell me — are you on fire?" he asked.
"No, I'm not on fire."
"Good. Now get a grip and relax," he ordered. "A rising PSA is not a death sentence. Chances are slim to none it's even cancer."
I've spent most of my adult life working as a journalist and an author, so I took my friend's advice. Having gathered my wits, I set about turning my fear into the same skepticism and curiosity that have stood me well on thousands of stories. Investigate! Get informed! Become my own expert!
Since that time, I've amassed a head full of results, facts, medical opinions and statistics on screenings for prostate cancer.
Five different studies, involving tens of thousands of men, showed that 7 out of 8 men with elevated PSAs will be cancer-free. Other studies found that having sex can raise your PSA (prostate specific antigen) levels, as can prostatitis, urinary tract infections, vigorous exercise and ibuprofen. This means that 88% of the men with elevated PSAs have what are known as "false positives."
Of those who do test positive for cancer, the vast majority have non-life-threatening cancers.
It was clear from my research that disagreement was growing among medical experts over the value of PSA screening. Richard J. Ablin, emeritus professor at the University of Arizona and a pioneering PSA researcher, came to call the use of his work "a profit-driven public health disaster." In his view (and those of many others), tens of thousands of unnecessary surgical procedures are being performed each year because of PSA tests, at a cost of tens of billions of dollars.
In October, the U.S. Preventive Services Task Force (an independent board that advises the government on preventive medicine) made big news when it recommended that doctors stop using the PSA blood test to screen healthy men for prostate cancer.
The report unleashed a firestorm of negative reaction from urologists (prostate specialists), just as the task force had expected. The panel had already navigated a similar storm in 2009 after advising doctors to stop using mammograms to screen normal-risk women in their 40s for breast cancer.
Dr. Michael L. LeFever, co-vice chairman of the task force, delayed the PSA-test announcement for two years to review the data, explaining when the recommendations were made public, "We absolutely have to have the science right."
These new studies and recommendations present men with a stubborn paradox. Despite testimonials from numerous men and women who believe that PSA tests and mammograms saved their lives (truth with a small t), the overwhelming evidence points to very different conclusions for most (truth with a big T).
Upon releasing his own study on the effectiveness of mammograms in screening for breast cancer, Dartmouth Medical School researcher Dr. H. Gilbert Welch described the conundrum this way: "The presumption often is that anyone who has had cancer detected has survived because of the test, but that's not true. In fact, and I hate to say this, in screen- detected breast and prostate cancer, survivors are more likely to have been overdiagnosed than actually helped by the test."
The medical community too faces very prickly questions about primum non nocere — "First, do no harm" — the vow every doctor makes when he or she takes the Hippocratic Oath. The verdict now in on prostate screenings and mammogram tells us that thousands of doctors in the United States are probably doing their patients more harm than good. This is the elephant in the national medicine chest.
None of this is to say that these cancers are not killers. Unfortunately, studies also show that early detection makes very little difference in mortality rates among people afflicted with the most aggressive kinds. In the context of cancer, Einstein was wrong. God does roll dice.
On the flip side, the vast majority of men who contract prostate cancer will die with the cancer, not of it, because the cancers grow too slowly to hurt them.
