**This post will be a bit more medical than most of my posts, but prostate health is very intimately related to sexual health, so I wanted to share.
In May, the U.S. Preventive Services Task Force made quite a wave when it released a recommendation against the use of the PSA Test for routine prostate cancer screening in healthy men who have no symptoms of the disease.
They conclude that PSA testing for early detection may do more harm than good.
This recommendation has been met with a fair bit of resistance from medical professionals as well as patients, but there’s a lot of evidence to support the idea.
The PSA test, which the task force recommends against, is a blood test that is a mainstay of screening for early detection of prostate cancer. Prostate cancer is almost always asymptomatic until the disease is very advanced, and the vast majority of diagnoses are made through screening in the total absence of symptoms.
Because prostate cancers that show symptoms are often very advanced, many medical professionals have (and some still do) strongly advocated screening for early detection.
The idea was that by finding the cancer in its early stages, you could cure it, usually by surgically removing the gland or sometimes through radiation therapy. But if the cancer had already spread beyond the gland, it would be too late for a complete cure. For this reason, many felt that early detection would save lives.
However, in recent years a lot of medical professionals have taken issue with this approach. Here’s why: many cases of prostate cancer are very slow growing. So slow in fact that it is possible for a man to have prostate cancer that will never become life-threatening or even cause symptoms, and he may die of other causes without the cancer ever causing any trouble at all.
The problem with the PSA test is that it cannot tell the difference between cancers that will or will not shorten a man’s lifetime.
That means that quite a lot of men are suffering through prostate cancer diagnosis and treatment to cure a disease that would never have killed them or even made itself known with symptoms.
For these men, screening comes at a high cost. The diagnosis alone is enough to completely derail your life: “you have cancer” and the floor falls out from beneath you. To say that a cancer diagnosis can cause severe psychological stress might be the understatement of the year.
The diagnosis would be made after a biopsy, during which needles are inserted into the prostate in several different locations to take tissue samples for testing. Sometimes this is done more than once.
And in case that didn’t sound bad enough, according to the task force, “roughly one third of men who have prostate biopsy experience pain, fever, bleeding, infection, transient urinary difficulties, or other issues requiring clinician follow-up that the men consider a ‘moderate or major problem’; approximately 1% require hospitalization.”
Of course, most men who are diagnosed choose to move forward with treatment. It must be very hard to know that you have cancer and to refrain from taking action to get rid of it. About 90% get treated, according to the task force.
The main forms of treatment are surgical removal of the gland, radiation therapy, or androgen deprivation therapy. The harms that might occur vary with each treatment, but they include: urinary incontinence, erectile dysfunction, infertility and bowel dysfunction.
These can mean significant loss of quality of life for the remainder of the man’s lifetime. Not to mention the financial burden of medical procedures and the lost time spent in appointments, in recovery from treatment, and in all-consuming stress and overwhelm.
But surely, you might say, all of these risks are nothing in the face of death? It must be worth it to save a life, right?
Sadly, the task force concludes that very few men have their lives extended as a result of PSA screening: “There is convincing evidence that the number of men who avoid dying of prostate cancer because of screening after 10 to 14 years is, at best, very small.”
This conclusion is largely based on 2 recent studies that followed men for more than a decade. One study found that men were not any less likely to die from prostate cancer as a result of early detection versus simply seeing a doctor when symptoms arose. The other suggested that approximately 1 man out of 1,000 men screened will have his life extended as a result of early detection, though the average age of death for men screened was the same as the average mortality rate of the studied population generally.
So, the task force argues, screening stands to benefit a very small number of men, and the number of men harmed in all the ways outlined above far outweighs the number of men who will benefit.
Ultimately, each man must make the decision for himself whether or not to pursue screening through the PSA test. As is noted in the recommendation, many men will continue to seek it and many doctors will continue to offer it.
But the task force recommendation does a good job of bringing to light the potential harms of screening, which must be taken into consideration alongside the potential benefits.
If you’d like to read the recommendation yourself, you can find it here.