By Ralph Blum
Maybe it’s shabby of me to immediately think: It’s all about money. The pot of gold at the end of the prostate cancer rainbow. Well, the first dip into that pot is billing for all those PSA tests, DREs and biopsies. Standard screening procedures, right? Only it’s not that clear cut. More and more these days, I tend to consult with Dr. Google. Turns out there is disagreement in high places.
The American Board of Family Practice regards screening as less than effective; they don’t recommend it for prostate cancer. Meanwhile the American Urological Association staunchly maintains that screening saves a lot of lives—even if, as one urologist told me, “Thanks to screening, I may end up doing 38 unnecessary radical prostatectomies to save one life.” When you get a specialty board at odds with a family practice group, it makes you think.
Then you have both the American Urological Society and the American Cancer Society discouraging screening for men whose life expectancy is 10 years or less. Why? Because the cancer, in most cases, is so slow growing that it can take that long for screening to prove useful. And besides, those men will probably die with it, not from it. Gina Kolata, science reporter for the New York Times, published an article “Screening Prostates at Any Age.” The piece opened with the question: “When, if ever, are people just too old to benefit from cancer screening?” Apparently never.
A recent study published in The Journal of Clinical Oncology reported that men in their 70s are being screened at almost twice the rate of men in their 50s. What’s that all about, given the life expectancy at that age? The study also found that men from 80 to 85 are screened as often as men in their 50s. Can you hear the chorus of clanging cash registers in the background?
Perhaps there is a more tolerant way to look at what, at first glance, appears to be blatant over-screening. Is it possible, Kolata wonders in her Times article, that late and continued screening provides a psychological “boost” for older men? A kind of placebo effect in the form of “evidence that death is not waiting in the wings?” (Some kind of Botox treatment for us sagging old geezers?) Obviously the cancer industry profits handsomely from that “delusive obsession.”
Fact: Some 50-year-olds do not require screening; some 75-year-olds may benefit from it. Certain prostate cancers are highly aggressive but do not produce much PSA. At the same time, since prostate cancer is usually asymptomatic until well advanced, plenty of doctors I respect consider it dereliction of duty not to screen for and detect it when it is still curable. Hard to argue with that logic. The burden is on the doctor to prove the guy doesn’t have cancer. Which is why he orders the screening tests just like he orders a cholesterol test or CBC (Complete Blood Count) for anyone over 50. And then there are all the “diagnostic tests. . .” Still, as the saying goes, ‘Better safe than sorry’.” Your doc doesn’t want to hear from the lawyer for your estate.
As my departed friend, NBC White Paper producer Fred Freed never tired of saying, “There are no easy answers.” To confirm the truth of that dictum for this cancer, you ought to attend a monthly meeting of the Prostate Cancer Club at Michael Milken’s Santa Monica Headquarters, and listen to 30 or more of LA’s top urologists, prostate and radiation oncologists and diagnostic radiologists arguing over a dozen or so current papers on all aspects of prostate cancer, none of which command widespread consensus.
Why should screening be an exception? Keep it simple: If you have reason to think you may be at risk for prostate cancer, get screened. If not, go fishing. Or buy yourself a new putter. If you’re rising 80 and off having fun with your sweetie, ignorance may not be bliss, but it sure can contribute to your quality of life.
About Ralph Blum (1932-2016)
Ralph H. Blum was a cultural anthropologist and author, graduated Phi Beta Kappa from Harvard University with a degree in Russian Studies. His reporting from the Soviet Union, the first of its kind for The New Yorker (1961—1965), included two three-part series on Russian cultural life. He wrote for various magazines, among them Reader’s Digest, Cosmopolitan, and Vogue. Blum has published three novels and five nonfiction books. He lived with prostate cancer, without radical intervention, for twenty years.