I received my Costco Connection magazine in the mail recently and noticed that it contained an article on prostate cancer. The subtitle was “Why your best shot at beating it is early detection.” I knew I was in for a rough ride.
The article started with a common story-telling technique. It used a sports figure, in this case a former NFL player, to convince his fellow men that he is alive today because his prostate cancer was detected early. In 2009, the NFL launched a campaign with the American Urological Association to promote prostate cancer screening.
The article included other positivity-laden, but trite phrases such as “. . . it was [vital] to become proactive and get educated about the disease,” and “. . . my disease was caught early, when it was the most treatable, and my kids will still have their father.” The article provided no stats or evidence to back up these claims, just a lot of quotes from celebrities and urologists.
As many non-urologists and non-oncologists know, any form of prostate cancer screening is controversial. In 2008, the U.S. Preventive Services Task Force concluded “. . . the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.” No screening should occur after age 75.
A meta-analysis of 6 prostate cancer screening trials in 2010 concluded that “The existing evidence from randomized controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination.” Neither the overall mortality rate nor the prostate cancer death rate was different between the screened and unscreened men.
A more balanced assessment of this issue is: now there’s proof that prostate cancer screening doesn’t do a darn bit of good, and adding more clinical trials to the mix won’t change this reality. This conclusion certainly wasn’t in the Costco article.
I used the magic of Google to find this author and I learned from writers’ websites that she has a multi-year background in journalism. I emailed her asking what happened to her skeptical journalist brain? If urologists make money doing the PSA tests and more importantly all the procedures that emanate from the test, did the thought cross her mind that — at a minimum — issues of self-interest might cloud their judgment?
In contrast, if a business person told this reporter that for only $3,000 men could purchase a set of ionic underwear, which if worn daily would reduce the risk of prostate cancer, would she just believe it? I bet the doubting journalist brain would be activated and she would insist on some sort of proof and demand to know how much of the $3,000 was going into the seller’s pocket. When talking to a urologist, she apparently acquired a case of white coat trance.
She never wrote back to me. I told her the misinformation she perpetuated contributed to false hope among middle-aged men and contributed to America’s exorbitantly expensive wasteful healthcare system. If she’s ever asked to write a story on unnecessary tests, I suggested she should pull up her prostate cancer article. Maybe that’s why she didn’t write back.
Even under the most ridiculously optimistic assumptions, at best prostate cancer screening is extremely rarely beneficial and costs a ton of money, with no long term savings to make up for the initial expenses. To give the public a more accurate impression of what the PSA test does for our healthcare system, I say we should rename it the Procedure Stimulating Antigen.
At least there are data to back up this definition.