One doctor’s experience with the PSA test

Any reader of this blog knows that we’d always choose data over anecdotes. This is true even when discussing the use of PSA tests to screen for prostate cancer. But every once in a while, a well-told story can put everything in perspective. One such story appeared in yesterday’s Archives of Internal Medicine:

Fast forward 5 years: cancer free. However, as a result of the surgery, my right arm and right leg are permanently weak, with this deficit appearing immediately after surgery. The reasons for this outcome are unclear. My PSA level remains 0, but my daily 5-mile jog is no longer possible.

Where am I now on the PSA dilemma in light of the recent US Preventive Services Task Force recommendations? It is clear that prostatectomy results in a very high chance of 20-year prostate cancer–specific survival, but even when the procedure is performed by an expert urologist, it can also result in significant rates of sexual, bladder, and bowel dysfunction and other less common adverse effects, such as my weakness. Active surveillance with longitudinal PSA tests and physical examination is associated with very low rates of bowel, bladder, and sexual dysfunction and has a high probability of correctly identifying when to move from surveillance to treatment. If I could do it all over again, I would not undergo the surgery; instead, I would opt for active surveillance. Even the most informed patient (me in this case) has difficulty making a truly informed decision.

Screening is not an unequivocal good. It can cause harm. Moreover, it can cost a lot of money. We have to remember that before we just join in lockstep with more and more screening in pursuit of the earliest possible diagnosis. We’ve discussed the studies. But I know some of you need a story.

Read the whole thing. It’s worth your time.

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