Oct 12, 2011 8:42 PM GMT
The fact that cost savings plays such a role in making decisions like this is scary when there is no recourse from what a government health panel will or will not cover. That's why competition works.
For men living with a diagnosis of prostate cancer, the news that the P.S.A. test does more harm than good has been unsettling and confusing.
After all, that is the test that first led to their diagnosis — and, often, a painful and traumatic course of treatment.
And now they tell us it doesn’t work?
“You will find mixed opinions from those of us who had to deal with it,” said a 78-year-old man from Boston who was left impotent and incontinent after his prostate was removed 11 years ago. “My current feeling is not anger; it’s sadness that I probably made the wrong choices and the consequences were both negative and not expected.” (He and another man quoted in this column asked not to be identified.)
This week, the United States Preventive Services Task Force is expected to announce its recommendation against routine testing for blood levels of prostate-specific antigen, the protein that can be a signal of prostate cancer. The panel says research shows that over all, the test does not save lives and leads to unnecessary surgery and radiation treatment for slow-growing cancers that would never have caused harm. As for faster-growing, invasive cancers, there’s no proof that P.S.A. tests and earlier treatment offer any overall benefit.
Many men do remain convinced that the test saved their lives by helping their doctors detect cancer in its earliest stages. But others are now left second-guessing their decisions, questioning a medical system that pressured them not only to undergo screening, but to be treated aggressively once cancer was detected.
Ten years ago, several doctors urged William Lewis of Washington, now 69, to have his prostate removed after a spike in his P.S.A. levels led to a biopsy and a diagnosis of cancer. But his own research led him to a “watchful waiting” program at Johns Hopkins School of Medicine, where he now undergoes regular checkups and biopsies to make sure his cancer hasn’t progressed.
“My urologist said, ‘Definitely prostatectomy,’ as did other people,” Mr. Lewis said. But “absolutely nothing has showed up that would suggest treatment is in order.