Health and medical information

Recently, one group of doctors looked at PSA, transrectal ultrasound and digital rectal exam. They found these tests to be unhelpful, questioned their cost-effectiveness, and concluded that “screening for prostate cancer represents a clinical dilemma with no clear evidence to suggest decreased mortality from any diagnostic test.” Critics have contended that PSA test results could prompt thousands of men to have unnecessary and expensive diagnostic procedures, which might lead to unnecessary surgery One leading magazine told its readers that PSA “could do more harm than good by leading to premature biopsy or treatment”; that the biopsies it prompts are “an infection waiting to happen” (actually, this is not the case; see the “Biopsy” section in this chapter); and that the PSA test can be wrong “four times out of ten.”

Doctors at a National Cancer Institute meeting took the PSA arguments several steps further. Many men over age 50 have cancerous cells in their prostates, they said, but just a small percentage of men die from prostate cancer. Most prostate cancer, they argued, is slow-growing and causes no problems. As one doctor told a New York Times reporter: “There are millions and millions of American men who have this cancer and are never ill, yet these powerful tests (PSA) are going to detect them. If the PSA is elevated, the chance that it is prostate cancer is relatively small. But even if it does represent prostate cancer, there is no way to know whether testing and treatment change the outcome or improve the health of patients.” Some doctors went so far as to state that men should sign informed consent agreements before getting a PSA test. “The information you get back can lead you down a cascade of interventions that can be deadly,” one doctor said, citing controversial statistics from a Medicare study for incontinence, impotence, rectal injury, and death resulting from surgery to remove prostate cancer.

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