Pushback in the Flap Over Prostate Test
By Jane Glenn Haas
Last month, the U.S. Preventive Services Task Force recommended physicians stop ordering routine tests to detect prostate cancer in men.
The risks, says the study group, outweigh the benefits.
Howls of protest followed from various physicians groups, including an adamant dismissal of the recommendation by Irvine-based radiation oncologist Dr. Kenneth M. Tokita. Tokita, head of the Irvine Cancer Center, insists all men should have an initial prostate-specific antigen test at age 40 to determine their risk level for cancer.
Dr. Tokita says,
"The recent controversy of "drawing too many PSAs" is a sad replay of heart and breast cancer controversies in the '70s and '80s. We were urged not to study the heart so vigorously as too many unnecessary studies and surgeries were being carried out. In the 1980s, we were urged to stop ordering so many mammograms. In both instances, the front line physicians tried to ignore the recommendations."
Q. Why are you advocating this testing?
A. The percentage of men with advanced prostate cancer at the time of diagnosis has decreased by 75 percent in the U.S. since the PSA era began in the late '80s. Death rates have fallen in the U.S. and globally since the testing began. Still, prostate cancer is the second most common cause of cancer deaths in the U.S. Even with this statistic, deaths have decreased by 37 percent and American men are now living eight years longer.
Q. Does PSA testing do more harm than good, as some experts say?
A. We now know that almost any man living to be 90 will get prostate cancer. The percentage is staggering, but it is very curable.
However, if you don't know you have cancer, you can't make a decision about your own care. If you wait until the PSA is too high, the cure rate drops dramatically. If the PSA is low, the cure rate approaches 95 percent today.
Q. Doesn't this cancer grow slowly?
A. Indeed, some prostate cancers grow slowly, but experienced urologists and radiation oncologists are well aware of those they can comfortably watch and those that better be treated. The aggressive ones are very dangerous, but fortunately can now often be treated if picked up early enough.
Q. So you do not feel too many men are being treated?
A. "Too many men are being treated." What an insulting statement.
Q. Are the complications of treatment greater than the complications seen in a man with metastatic cancer disease and death?
A. The complication rates today of radiation and surgery are very low and in the single digits, percentage-wise. We know 100 percent of uncured patients will suffer serious consequences of bone pain, tremendous amount of medical treatment and agonizing deaths.
In 40 years, I have seen prostate cure rates rise from 0 percent in the early 1970s to more than 90 percent overall today. What are these people thinking of when they make such serious and insane recommendations?
Next: New ways to treat prostate cancer
Contact Jane Glenn Haas
Published June 20, 2012