I’ve been following with interest the fallout from a federal task force conclusion that most men should not routinely get the PSA blood test for evidence of prostate cancer. I got the test back in 1994 and had my prostate surgically removed in 1995. A post-operative PSA test showed that cancer cells remained, and I’ve had the test every six months since then.
Now, the U.S. Preventive Services Task Force has concluded that the exam does not save lives and may even lead to harm for 20-30% of men. (These PSA recommendations are proposed and still have to go through a comment and review procedure.)
PSA, Prostate Cancer and Me
I began getting PSA tests every six months when I turned 60. Five years later – in 1994 — my PSA number escalated. A biopsy showed the presence of cancer at state B-1 (A is so miniscule it often goes undetected; C and D cancers have probably spread beyond the prostate).
My urologist said the biopsy on the removed prostate clearly reconfirmed the rightness of our decision to operate. He also said there wasn’t always such definite clarity in these cases.
- Let the government collect and provide the best information, but leave it to the doctor and patient to make the decision? This option probably wouldn’t cut costs. Doctors are usually reluctant to recommend against a test or procedure. Many patients don’t try to inform themselves or take an active role in managing their own health care. And families typically recommend the “do something” option.
- Let the government and/or insurance companies play a more aggressive role by declining reimbursement for tests or procedures if evidence shows they don’t do much good or even cause harm? The current PSA flap reflects the concern many people have that the task force’s recommendations are moving us in this direction.
It’s a dilemma. I want to play an active role in these decisions, with my doctors. But I also think my doctor and I – like most other patients and professionals — will tend to choose options that create needless cost and even unexpected harm.