A prostate cancer diagnosis through PSA screening and other tests is easy to determine but has become increasingly controversial. In my current National Prostate Cancer Awareness Tour since this past June, I've encouraged men to get an annual PSA and DRE exam.
I continue to argue for this even after reading and hearing the American Cancer Society's controversial position about refraining from PSA screenings, recently noted in the New York Times and on ABC Evening News.
The question of PSA screenings led me, as author of Conquer Prostate Cancer and this blog, to have a lengthy private conversation a couple of months ago with the ACS Chief Medical Officer, Dr. Otis Brawley. As it turns Dr. Otis has now publicly expressed these same thoughts in the media noted above. In doing so he began the current firestorm of reactions on the part of countless patients, survivors and doctors - and WOMEN, since he voiced his admonition against both prostate and breast cancer screenings - meaning routine screenings when a person has no symptoms.
When speaking with Dr. Brawley about his anti-PSA screening stance, I told him that ignorance is not bliss, and that every man has the right to know what's going on inside his own body by means of PSA screening or other tests. So does every woman who is a man's significant other, have a right to know what's going on inside his body, as well as her own vis a vis annual mammograms.
In my view It's only then that a man, in discussion with his spouse/ partner and doctor, can and should determine if he's likely to need a biopsy, which I believe will be the case in most instances where his PSA has gone up a point or more in a year or has reached an abnormally high level.
In my view the problem is not whether men need PSA exams or biopsies. To me that’s a “red herring” which has led us to avoid the real issue. To start with the more important issue is what treatment option he needs to choose, whether it be active surveillance (aka, "active waiting"), some form of radiotherapy, or a prostatectomy, and perhaps some subsequent treatment like salvage radiotherapy or hormone therapy, - all of which are far more aggressive than watchful waiting.
The second paramount issue is the need for scientific progress to determine which tumor is unlikely to be lethal, and which will become fatal. Our science is flawed. We are now only on the brink of discovering which cancers are likely to become more aggressive...requiring corresponding aggressive treatment, and which are not, and only require active monitoring. Scientists who are already working on this problem need to figure this out sooner rather than later.
Another scientific disconnect is that biopsies themselves are random "samplings" - whether a doctor uses six, eight, ten, twelve or more core tissue samples to identify if a prostate is cancerous. Trust me I know, since two years before my own radical prostatectomy there was no evidence of prostate cancer in an earlier biopsy, and then in January 2007 another biopsy suddenly revealed the presence of a tumor, which proved to be contained within my prostate as determined by my subsequent bone and CAT scans.
We also have to take into account the human factor: Is a man going to become nerve-wracked, wondering if he has cancer that will compromise his health and might even kill him, even though he's among the 80% of those newly diagnosed with early stage prostate cancer. OR is a man going to be less anxious by avoiding any screening, allowing him to assume or presume he's in good health due to the absence of any symptoms of prostate cancer?
Every man in conjunction with his doctor and with a full understanding of the risks and benefits of each treatment option, needs to decide for himself whether or not to be screened and tested further for prostate cancer. It's up to the patient to make that decision, in conjunction with his significant other. Ultimately this should not be a decision made by his doctor alone and certainly not by the public healthcare system or by a private, voluntary organization with its conflicting guidelines, such as the American Cancer Society, - based in large measure on flawed and incomplete data.
For all this, I would argue that, whatever your view about PSA screenings, we can agree on a couple of basic premises: One is that doctors need to be far more detailed and BALANCED in depicting the risks and benefits of any of the many treatment options a man can take when a tumor is diagnosed. Above all doctors need to work in partnership with their patients to spell everything out and to offer comprehensive assessments verbally and in writing.
In addition patients need to become active members of their medical healthcare team. By that I mean they should be as proactive as possible by reading recommended, current literature by doctors and "expert" prostate cancer patients like myself and others, before rushing to judgment.
A second premise is that prostate cancer is generally slow-growing. As a result, if you’re a prostate cancer patient you can and should take your time to determine what's in your best interest. Now that’s something we can and should all agree on.