Dispatches from the PSA Front: What You Don’t Know May Be Good for You

RALPH BLUM

There is a growing sense that those who are medically challenged—in this case the challenge being prostate cancer—are just another population of “consumers” in Big Pharma’s drive to capture market share.

                                   

Boil it down and the issue here can be stated in just three words: overtreatment by doctors. It is ironic that the first serious warning came from Thomas Stamey, M.D., formerly Chief of Urology at Stanford University, the man who developed the PSA blood test. Stamey’s dire prediction should be part of the awareness of every urologist and every newly diagnosed man:

“I believe that when the final chapters of this disease are written, it will prove that never in the history of oncology, will so many men have been so over-treated for one disease.”

One rarely sees Stamey’s warning reprinted. Why not? “Bad for business,” one urologist admitted to us.

           

However, concern for this situation is expanding rapidly. An October 5, 2011 New York Times article by Shannon Brownlee and Jeanne Lenzer quoted one of the major figures in the field, Otis Brawley, currently Chief Medical and Scientific Officer of the American Cancer Society, who the authors describe as “the public face of the cancer establishment. Brawley has become the target for attacks because of “his blunt and very public skepticism about the routine use of the prostate-specific antigen, or PSA, to screen men for early prostate cancer.” Brawley’s position is unequivocal and disturbing to the medical establishment:

“I’m not against prostate-cancer screening. I’m against lying to men. I’m against exaggerating the evidence to get men to get screened. We should tell people what we know, what we don’t know and what we simply believe.”

Otis Brawley, who is also a professor of oncology and epidemiology at Emory University, is foremost among a growing number of urologists and oncologists who recognize the ethical obligation to make certain that men grasp the nature of the radical “downstream decisions” they might have to face as a result of early screening—or any screening at all.                                                       

The newly identified risk of knowing too much is redressed when men are given balanced information about both the pros and cons of P.S.A. testing. Studies have found that well-informed men are less likely to opt for screening than men who were merely offered the test. “If a man understands the risks and benefits and does not want to be screened, that decision should be supported,” Brawley says. “But just saying that gets you in trouble.”

Well, that is changing, and changing fast. Since we posted our blog, “Who’s Afraid of a PSA?” the word is out. As I write this blog, I am receiving calls referring me to the latest Oncology Today, and also suggesting I Google: “Breaking News: PSA tests no longer generally recommended. “

It appears that we are entering a time when PSA testing is no longer done automatically as part of a doctor visit or a check-up with your urologist. A time when men will receive explanations as to the necessity for testing—and ask for explanations if they are not forthcoming. A time when there will be more transparency regarding the possible adverse side effects of PSA testing, the most egregious side effect being unnecessary aggressive treatment.

And meanwhile, hats off to Tom Stamey and Otis Brawley!