Ignorance is Not Bliss: PSA Test Saves Men’s Lives from Prostate Cancer

This week we await the official no-PSA recommendation from the United States Preventive Services Task Force (USPSTF), but the backlash is well underway. Based on concerns that further testing and even treatment may cause more harm than good, the panel of primary care physicians plans to advise all healthy men to avoid annual PSA screenings for prostate cancer.

In press and public outcry, it’s plain to see that both sides of the fence are well populated in this debate. One of the primary arguments against screening is the test’s inability to distinguish between very common, benign prostate cancer and more serious, advanced prostate cancer. Further, there is substantial belief that prostate cancer is an inevitable disease for men, that by the time men are in their sixties 70% may already have it. The task force believes that for most, prostate cancer is so small and meaningless that they should let the sleeping giant lie.

But if you ask those men with cancer they may disagree, those who know they have it and those who don’t know. “In just the past few days I’ve met with many men who are concerned about the panel’s call,” says Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center. “If insurance companies start listening, these men fear they’ll lose their right to testing and they’ll spend their lives worrying and wondering.”

Though insurance companies and Medicare are not required to act on recommendations from the Department of Health panel, they often do, which could mean the test will no longer be covered.

“These physicians have just made our jobs much harder,” says Dr. Samadi, “We’re no longer just fighting prostate cancer; we’re fighting misguided government guidelines.”

Many prostate cancer specialists like Dr. Samadi devote a great deal of time to spreading the word about prostate cancer. For younger, healthy men there is strong evidence in support of the annual screening. From 1990 to 2007 we saw a 39 percent decrease in prostate cancer mortality thanks to early detection and treatment. The panel still recommends the test for those displaying symptoms of prostate cancer, risky business according to Dr. Samadi who reminds that the disease often has no symptoms until it has metastasized.

The USPSTF’s message about PSA testing places blame on potential negative side effects of both biopsy and treatment, drawing the conclusion that if men don’t know they have cancer they won’t feel obligated to act and won’t choose an option that they’ll regret.

Early detection saves lives

“There is proof that early detection saves lives and there are treatment options that work,” says Dr. Samadi. One such treatment is robotic prostatectomy surgery, the complete removal of the cancerous prostate through robot prostatectomy surgery. Dr. Samadi uses his own SMART (Samadi Modified Assisted Robotic Technique) with great success. “I know men are afraid of prostate cancer, not because it’s cancer, but because they’ve heard the stories about incontinence and sexual problems. It doesn’t have to go that way,” assures Dr. Samadi. His technique achieves continence in 97% of patients and sexual potency in 81% of patients within the first year.

Dr. Samadi knows the PSA test is not yet perfect, but cannot understand the panel’s decision to eliminate it. “It’s as if they said, ‘Some people are injured by seatbelts during car accidents, so let’s tell everyone to stop using them until someone invents something better.’ They’re completely discounting the lives that are saved. It makes no sense and it’s irresponsible.”

Researchers continue to work on developing prostate cancer screening tools that are more sensitive to the variations in the disease, but until that time the PSA test is a viable and useful tool.

“To stop now would be to surrender to prostate cancer,” cautions Dr. Samadi.