I'm pleased to see that my op-ed piece in the Buffalo News may, at least in some small way, have more people there and elsewhere talking about a more complete picture of the not-so-simple prostate cancer screening decision.
First, it led the Roswell Park cancer center to post an "important message" on its website. In it, Dr. James Mohler, chairman of urology at Roswell Park wrote,
Talking to one's doctor about screening is not the same as being treated, and we believe that Mr. Schwitzer muddies those issues. Is his takeaway message to men: Don't talk to your physician? Is it: What you know can hurt you?
I don't believe my message was muddled at all. And there was nothing in my message that even indirectly hinted at discouraging men from talking with their doctors. What I wrote about was the uneven, imbalanced, incomplete promotion of prostate cancer screening. Whether the information comes from a news story, an ad, from your doctor, or from a website promotion, it should be balanced and as complete as possible. There is no reason why the Roswell Park prostate club promotion had to be so simplistic and incomplete.
Finally, after the op-ed section of the Buffalo News published my editorial, the news department published a news story on the recent public screening discussions. In it, Roswell Park's Dr. Mohler was again quoted:
"What we're seeing is the unintelligent use of the PSA test. We need to be screening everyone at risk of death and not everyone," said Dr. Mohler."The PSA has overshot its goal," he said. "It often finds prostate cancer when it is so low-risk that it doesn't need to be treated," he said. "But you also can't deny that the death rate for prostate cancer has fallen 40 percent since the PSA."
Actually, anyone in epidemiology or biostatistics would remind you that one of the explanations for a falling death rate could be that the pool of prostate cancer has become so expanded after the introduction of the PSA blood test. So if you're finding many more abnormalities very early - what some would even call pseudo-cancers - but still calling them cancers - and saw no improvement in treatment, you could still see a dramatic fall in the death rate because the pool of "cancers" - the denominator - would be so much larger.
This, too, is part of the education of the American public that needs to take place.
The studies showing that PSA screening does not save lives arguably are quite poorly designed studies. For one thing, they don't follow subjects for long enough for prostate cancer to cause death. Thus, I believe the American study follows subjects for only ten years but many prostate cancers that are caught early would not have caused death until 12-15 years or more, so the study would underestimate the number of lives saved by screening. The 15 years may not be significant for a 75 year old but very significant for a 55 year old who may have lived into his 80's or 90's if his cancer was caught early enough.