A group of local men, all prostate cancer survivors who meet regularly in an information-sharing and support group, reacted to a panel of experts’ recent recommendation against a test that screens for prostate cancer (prostate specific antigen, PSA test). Collectively, they were incredulous about the panel’s recommendation.
“The test is non-invasive and costs little to run,” said Bob Schraff. “It’s a simple blood workup. My urologist said the recommendation is bulls**t. He said it’s the cheapest test that they can run.”
The group meets monthly to give other men who are facing either a prostate biopsy or surgery a sounding board, according to Schraff.
“Several of the guys, when they had gotten the information from their doctors [about an elevated PSA. or possibly need for surgery] went home and wrote their wills,” he said. Schraff noted the men in his group who have been through surgery and have not experienced any negative after-effects, reassure those who are just beginning the process.
The United States Preventive Services Task Force (USPSTF), an independent panel of non-Federal experts in prevention and evidence-based medicine, recommended against a PSA test for non-symptomatic men. Its October recommendation to avoid PSA testing is raising eyebrows among many men, such as the Idyllwild group, as well as many health practitioners.”
The recommendation won’t change our practice at all [of administering PSA tests],” said Dr. Eric Klein, head of urology at the Cleveland Clinic, in an online interview. “We’ll still recommend routine screening.”
“Unfortunately, the evidence now shows that this test does not save men’s lives,” said Dr. Virginia Moyer, chair of the task force. The Idyllwild men strongly objected to that characterization. “The PSA test pushed me to the biopsy,” said Jeff Meltzer. Meltzer subsequently underwent robotic surgery because his biopsy proved positive. “The [health] costs of dealing with cancer later [after it has advanced] are so enormous, it is mindless not to have the test,” said Schraff.
Although the USPSTF reportedly does not consider cost when making recommendations, the men of the Idyllwild group believe a need to make overall reductions in health care expenditures drove, or at least influenced, the recommendation.
Some insurers said they intended to continue paying for the test, while others said they would revisit their policies on PSA testing. Both Aetna and Kaiser Permanente said they were not certain they would continue to pay for the test. “We are currently reviewing the USPSTF recent announcement on prostate cancer screening,” said Jason Allen, spokesman for Kaiser Permanente.
Statistically, one in six men in the U.S. will develop prostate cancer, but only one in 34 will die from it, according to the American Cancer Society. It is the second most common cancer among men, after skin cancer. The disease is rare before age 50. There are three types of the cancer, with the most slow growing being the most common and affecting 85 percent of those diagnosed with the disease.
According to available autopsy statistics, a study projected that a third of men ages 40 to 60 have the cancer but won’t die from it because of its slow growth. They would die from other causes, which is one of the principal reasons behind the panel recommendation.
Once cancer is detected, according to the panel, it is psychologically difficult for a man to do nothing. The other consideration men must face is potential reduction of sexual function after surgery, according to Journal of the American Medical Association study. The study of 1,000 subjects found that a man’s chances of returning to a somewhat normal sex life, depending on the extent of cancer and the type of treatment, can range from less than 10 to 70 percent or more.
The American Cancer Society recommends that men 50 and over have a conversation with their doctors about whether to have the test. The American Urological Association recommends the test be offered to men 40 or older.
The Idyllwild prostate cancer survivors all said they had talked to their sons and other younger male relatives about the need to have the tests. The group meets monthly at 6 p.m. the last Thursday of every month in the back room of the Gastrognome.