Do we fret too much over prostate cancer? | Arkansas News

By John Brummett

Medical studies have become notorious for sending frustratingly mixed signals to anxious people.

These sometimes contradictory findings vex Baby Boomers who seem to think they might live forever if only they would eat all the right foods and get all the right screenings.

But the darndest thing is this apparently emerging notion among medical experts that we?re all getting too many cancer tests because a little cancer probably wouldn?t kill you but the treatment might.

Actually, let?s be precise, since cancer remains the most sobering of subjects and lives could be at stake: That notion in the preceding paragraph goes only for prostate cancer in a report released last week by an eminent independent panel working for the federal Health and Human Services Department.

But surely you remember a similar report two years ago that said healthy women younger than 50 needn?t necessarily get mammograms and that healthy women older than 50 didn?t need a mammogram every year, but every other year.

That?s not necessarily a trend, but it?s certainly counterintuitive.

Women and their doctors seem to have ignored the mammogram report. It will be interesting to see what men, generally less inclined than women to go to the doctor for preventive care ? to speak in a broad gender stereotype ? will do with this latest information.

Men of a certain age tend to get tested involuntarily for their PSA, or prostate-specific antigen, which can signal the possibility of cancer if at an abnormally high level. It happens when they submit to what we all colloquially refer to as our ?blood work.? One part of the data coming back from the laboratory is the level of PSA. If it?s high the doctor will recommend a biopsy, then the biopsy might show cancer cells.

At that point, the man invariably will get frightened and inundated with options, with surgical removal of the prostate being a common one.

This panel says to stop that, at least for men who appear healthy and without symptoms, for these reasons:

First, high PSA could mean all sorts of things, and biopsies have risks.

Second, cancer of some level in the prostate is common in men after 40, but, in most cases, so slow-growing that it won?t kill a man any quicker than old age will.

Third, it?s human nature to want to do something proactive about cancer, any cancer, even if doing nothing is actually a reasonable option and even if, as in the case of prostate cancer, there?s usually not any pain or functional impairment. So maybe it?s best not to be bothered with the information in the first place, if only, that is, in regard to the prostate.

Fourth, prostate surgery can cause incontinence, impotence or other complication, conceivably even death. That means men are risking side effects that could reduce their quality of life because they received medical information that terrified them even if it needn?t.

Yes, the panel acknowledges, the occasional man forgoing the screening or treatment will get a more aggressive prostate cancer that will spread and start to hurt him and eventually kill him.

But the panel seems to be saying essentially ? and not to be flip ? that just because the occasional man has rotten luck and gets killed in a car wreck is no reason for all other men to turn themselves in for driving tests by which they might lose their licenses and see their qualify of life reduced.

This new study?s conclusion is that PSA testing gets a grade of ?D,? which means the risk of harm exceeds the prospect of benefits.

Here is what I predict will commonly happen: Nothing.

Doctors will tell men that, because of this new study, they will not run a PSA check in the blood work unless the man wants one. The man will say to go ahead and run the check because he is conditioned to believe it is the wisest course.

If the PSA comes back high, the man will want a biopsy. If there are cancer cells, the man will not be constitutionally capable of walking around blithely with cancer. Yank it out, or radiate it, or do something, he will say.

Any idea that any of us might treat any form of cancer as something to be lived with as a natural part of the aging process, and that living with cancer offers better odds than having it cut out ? that?s a long-term attitudinal change that will require at least a couple of generations to have even a chance of taking hold.

The distant day indeed might come when your grandchildren or great-grandchildren ? probably great-grandchildren ? lament your backwardness for having had your prostate gland radically removed for no better reason than that it had a little every-day, slow-growing cancer.

For the time being, that premise just seems nuts, no matter what an eminent panel of medical experts said the other day.

Now for another difficult issue: Should you eat an egg or not, and how often, and which part?

??-
John Brummett is an award-winning columnist for the Arkansas News Bureau in Little Rock and author of ?High Wire,? a book about Bill Clinton?s first year as president. His e-mail address is jbrummett@arkansasnews.com.

Source: http://arkansasnews.com/2011/10/10/do-we-fret-too-much-over-prostate-cancer/

gary johnson gary johnson rick santorum prime suspect prime suspect republican debate whitney