Debating how and how often to test for prostate cancer
February 6, 2012By Taunya English
When you sift through the raging aspect of this debate, the only people that are not confused are the patients...the patients, almost to a person, will tell you: 'Hey doc, I can handle it, if I have prostate cancer I want to know.'
-Urological oncologist Stuart Holden, Medical Director for the Prostate Cancer Foundation
African American men -- and others with a higher-than-usual risk for prostate cancer -- are at the middle of a debate about whether the main screening tool for the disease is any good at all.
For years, the government recommended that men age 50 and older get a prostate cancer screening test called the PSA.
The PSA test looks for a protein -- prostate-specific antigen -- which doctors use as a first step to detect disease in the walnut-sized gland just below a man's bladder.
High risk groups, including African American men, were told to start screening even earlier.
Seventy-year-old Benjamin Jackson, lives in the West Oak Lane section of Philadelphia. He followed doctor's orders for decades. Then, two years ago, worrisome PSA results led to more testing. Jackson had cancer.
"I guess at that time my mouth got dry as the desert -- I was all alone -- they said come in for further consultation," Jackson said. "I didn't even tell my wife, I didn't tell my wife for two weeks, just shell shocked, didn't know which way to go."
Jackson chose prostate removal surgery at Fox Chase Cancer Center, and he's cancer free now.
He believes regular PSA screening saved his life.
Still, when a national prevention-policy panel studied the research, it decided to give the PSA test its lowest letter grade. It's not clear, the panel concluded, that the harms from screening -- which can include unnecessary surgeries -- outweigh the benefits.
Urological oncologist Stuart Holden says the task force weighed-in too soon. He would like to see several more years of research to better judge the PSA's effectiveness in preventing death.
"Don't throw out the baby with the bath water. Let's learn how to use the PSA in a more appropriate way, which we are still learning about. They really jumped the gun, in my opinion," Holden said.
Holden is medical director for the Prostate Cancer Foundation. He concedes that the PSA is an imperfect tool. It can lead surgeons to perform unnecessary biopsies, and those procedures costs the health system millions of dollars. Still, he says, the PSA points to early-stage tumors that were missed 40 years ago when prostate cancer was often discovered too late for a cure.
"There's no question that PSA has changed the whole landscape," Holden said.
Critics say the test has also created new problems. The PSA can set off early alarms over a slow-moving disease that many physicians prefer just to monitor, rather than race to treat.
Watchful waiting is an option that lets men avoid radiation treatment or surgery, but Holden says it's hard to know, sometimes, which tumors are slow growing.
He still values the PSA.
"When you sift through the raging aspects of this debate, the only people that are not confused are the patients," Holden said. "The patients, almost to a person, will tell you: 'Hey doc, I can handle it. You test me. If I have prostate cancer I want to know.'"
Benjamin Jackson is a great-grandfather and has been with is wife for half a century. He says: Imagine if he'd skipped the PSA.
While the debate flares among experts, in Jackson's social circle, few men want to talk about screening or prostate cancer at all.
"From the end of October 2010 to December I was going through...excuse the expression...hell. I didn't have anyone to reach out to. That was the problem," Jackson said.
Weeks after his surgery friends stepped up.
"Five or six frat brothers said: 'Oh, I had it.' Everybody came out the woodwork. It's too late then. It's really too late," Jackson said. "I asked them, 'how come you didn't reach out?' It was: 'It's private,' they don't want to let people know they have cancer, it's like, it's personal."
At first, Jackson felt that way too, especially when he learned that surgery would likely diminish his sexual function. "That was harder than the cancer news," Jackson said with a smile.
He understands the reticence to talk, but thinks that keeps men isolated. A year after surgery, even Jackson hesitates -- a bit -- when asked about his intimate life.
"Sex life? Terrible, terrible. It is what it is. You either have it or you don't," Jackson said.
It's hard to talk about, but Jackson says, these days, he initiates conversations about the PSA, treatment options and all that can come later.
"Hey, I'm out here. Grab on to my hand, let's talk about it," Jackson said.
In The Gap: Voices from the Health Divide is a co-production of WHYY and WURD 900 AM. Taunya English will discuss this story at noon Tuesday, Jan. 7 on WURD's HealthQuest Live show.