Well, the United States Preventative Services Task Force (USPSTF ) has officially proclaimed that the harms of prostate screening outweigh the benefits. Why does this put me in mind of this humorous DirectTV commercial?
When you have cable and can’t find something good to watch, you get depressed …
when you get depressed, you attend seminars…
when you attend seminars, you feel like winner …
When you feel like a winner, you go to Vegas …
When you go to Vegas, you lose everything …
And when you lose everything, you sell your hair to a wig shop.
Don’t sell your hair to a wig shop. Get rid of cable and upgrade to DirectTV
The reality is that the PSA test is a simple blood test, and there are almost no potentially serious harms from a blood test. No, the harms that the USPSTF talks about—internal bleeding, incontinence, impotence—are all potential complications of steps you may take far down the road. If you get a PSA test and the numbers are high, you may decide to get a biopsy (or you may decide to get another test at some later time). If you get a biopsy it may show nothing, or it could indicate cancer in early or later stages. If the biopsy indicates cancer, you may decide to have it treated, or you may decide on “watchful waiting,” since prostate cancer grows so slowly and it may not be necessary to treat it at this time or ever.
But in the mind of the USPSTF, men are like the guy in the commercial—if we watch cable we will end up broke and selling our hair in Vegas. If we get a PSA test we will inevitably end up wearing a diaper, so don’t get that PSA test.
The fact is that we know a lot more now about the risks and benefits of prostate screening and treatment. The very information that the task force is basing its decision on is changing the calculus that men go through in deciding how to proceed. Much of the data about the risk benefit ratios also comes from the time before this information came out, when men were very likely to automatically get prostate surgery.
I would bet that in ten years, partly as a result of new information, the risk-benefit calculation will look very different, especially if you only look at younger men in their 40s and 50s (I love that my cohort counts as “younger men” when talking about prostate cancer). But instead of encouraging these changes, the task force has decided that it is better not to know anything, that it is better for men to stick their heads in the sand or stick their fingers in their ears on the subject of prostate cancer.