Tuesday, January 24, 2012

Does PSA Screening Save Lives?

Reader's Digest article from February 2012 issue

Yesterday I got into an exchange of nasty e-mails with my former classmate Jean.  Jean is the official Class Busybody who keeps all us remaining members of the Downingtown High School Class of 1959 informed of the doings, whereabouts, and who is still alive and who has died in our class.  She sends out an occasional e-mail to all surviving members of the class called "DHS Newsy."

I guess she is doing us all a service by keeping us all informed of our former classmates.  I'll admit, I am nosy and in my capacity of preparing the class reunion booklets I like to be informed to.

She sends me an e-mail last week, a few days after the death of yet another classmate asking me "How are you doing Ron?"  Of course I tell her of my Prostate Drama and my decision not to follow through with a biopsy.  You know me, Full Disclosure Ron (much to the chagrin of some of my friends and Bill).

She immediately sends me an e-mail telling me to "get your ass to your doctor and get that biopsy!"  Of course I took umbrage to her tone.  You have to know her, she is a total "I'm in charge and YOU LISTEN TO ME!"  She has done a lot of good for our class in bringing us together for reunions, which would probably never have happened without her IN CHARGE attitude.  But hey, whether I decided to get a prostate biopsy or not is NONE OF HER BUSINESS!

I haven't had the best past couple of weeks what with my cold, the gray dreary weather and the short days (lack of daylight does that to me).  So I shot her back an e-mail telling her basically to get her facts in order before she starts barking me orders.  She is one of these people who thinks she's an expert in everything.  I guess I was a little mean in pointing out to her that in this case she was NOT THE EXPERT and perhaps she should do a little reading up on PSA scores, and the dangers of getting prostate biopsies and treatment thereof before she starts her Big Mama Thing.  I told her that someone needed to tell her this.  Of course she DID NOT LIKE THIS.  She sent me a scathing e-mail back.  One of those "WELL, I NEVAH!"  Deal with it woman, deal with it.

Now wouldn't you know it, Bill comes across this article in Reader's Digest today.  I've taken it out of the magazine and scanned it into my computer.  I think you can read it.

The article says: 

"...only one in four men with a PSA between four and ten actually has prostate cancer- the rest are false positives.  And because the disease grows slowly in most cases, very few occurrences of prostate cancer are life-threatening.  In fact, less than three percent of all men will die of the disease.  Worse, the treatment for prostate cancer can cause serious side effect such as impotence and incontinence. "

The article goes on to say

"Healthy men don't need to be screened.  In October, the U.S. Preventive Services Task Force, a panel of health-care experts that sad vises many medical associations, concluded that the over diagnosis and over treatment that result from PSA screening outweigh the benefits.  The panel cited a 2009 European study of 182,000 men that concluded that more than 1,400 men would have to be regularly screened-and set on a path toward possible biopsies, surgeries, and anxiety as a result - to prevent a single prostate cancer death.  A similar 2009 study that followed nearly 77,000 American men for seven to ten eras found no evident that screening saves lives."

Of course every man has to make his own decision whether or not to get a PSA screening and to follow-through on biopsies and/or treatment.  I made my personal decision based on how I felt about my personal situation.  I do not and would not impose my decision on anyone else no do I want them imposing their decision on me.  So when someone tells me to "get your ass to my doctor and get a biopsy" I get mad.

Sorry lady, but you asked for it. You blast me, I blast you right back.  Something some of my friends know I am wont to do when talked to in a dismissive tone.  It's called The Tipton Temper.  It rarely makes an appearance but when it does...watch out.


  1. "get your ass to a doctor..." - Literally!!! LOL

    You clearly made the right decision and I bet it was great to read that article to back it up!

  2. I missed that literal meaning Hank! I'm very careful about what I do with my ass, very careful. :)

  3. Well, I'm sure that it is good to know that the diagnosis hasn't affected either of your egos.

    More seriously, what if the shoe were on the other foot - say a breast self examination that detected an irregularity that wasn't followed up by a mammogram? Would you be after her to "get her ass into the doctor?"

    The popular press publishes many things that appear to become standard practices -- and the use is later questioned. While I'm not willing to go back to bloodletting and leeches, I think that we have to remember that medicine is as much an art as a science and it is tied up with all the frailties, uncertainties and messiness of human beings. I question whether there are any simple and absolute solutions.

    You guys appear to have known each other long enough and care for each other enough to yell at each other (and yell back). My reccomendation(remembering that free advice is worth the price), is to pick up the phone. Talk....agree that you drove each other nuts...agree that each of you gets to make the decisions that affect your own body...agree that maybe there are some things that you won't share anymore...agree to disagree...thank her for being in your corner...and let her know that you will be in hers if the time should come (and mean it too). This isn't about anybody being right or who is "wrong" or who gets to have the last word. This is about being in relationship with another human being in ups and downs and sideways parts of life. We all need people in our lives who care as we go through life.

    Now, give me a hand and help me down off my soapbox before I lose my balance and fall. ;-)

  4. A positive spin is she is concerned for you. Best to thank her and do what you know is best.

    Worst comes to worse, tell her 'there ain't room enough in this dress for the both of us!"

  5. Interesting article. Kind of confirms things you've been hearing and what I've heard about, too. The PSA screen is a standard part of my annual blood work, and my numbers are always below 1, so it's not something I think about much.

    LOL'd at Hank's comment!

  6. Will J,

    A diagnosis for breast cancer is totally different than a high PSA score which may or may not indicate prostate cancer. Yes, both Jean and I have huge egos. Jean probably more so than mine. I usually let her get away with her bossy attitude and smart assed remarks but this time I just wasn't in my usual patient tolerant mood and I decided to give her some of her own medicine. It felt good. Sure, we're still friends but maybe next time she will think twice before spouting off. She doesn't like to be talked to that way nor do I.

  7. Dr.Spo,

    Beneath her massive ego, I think she really does care. But with Jean it's all about her and it felt good to tell her off. Sometimes I need to do that with people who think they can run my life. The worm turns as they say.

  8. Ron,

    Too bad you are not a lab mouse.



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