McGrath: When the cure is worse than the disease
By David McGrath mcgrathd@dupage.edu July 27, 2012 10:44PM
Updated: August 30, 2012 6:19AM
When it comes to cars, computers and golf swings, the old adage about not fixing “what ain’t broke” has been the motto in my household for years. Taking something apart that’s running OK can only lead to trouble.
But who knew that those words of wisdom can be applied to prostate glands?
I refer to the recent recommendation by the U.S. Preventive Services Task Force that doctors discontinue performing PSA tests for prostate cancer. As far as the task force is concerned, the Prostate-Specific Antigen test is unreliable because it results in too many false positives, 80 percent of which do not prove to be cancerous.
But it’s a simple lab test done in conjunction with other routine blood work during annual checkups, such as for diabetes or cholesterol, so what’s the harm?
Plenty, says the task force. First, a high PSA number triggers a painful biopsy, which is often accompanied by nasty side effects including infection, bleeding and problems urinating. And second, if the biopsy is positive, the treatment options can be worse than the cancer — causing pain, incontinence, impotence or death.
The task force concluded that no treatment often is preferable because most men diagnosed with prostate cancer, a very slow-growing cancer, are elderly and will die first from some other cause.
While many doctors remain skeptical of the task force’s conclusion, I, for one, welcomed this answer to the question of PSA testing. Several years ago, when the PSA was considered the gold standard for detecting prostate cancer, I saw an ad for free prostate cancer screening sponsored by a well-known national clinic.
At 58, I was in fine health and foresaw no downside to taking a free medical test. So I drove to the screening site, signed some papers and got in line. Blood was drawn and results were quickly tabulated, showing I had 2.81 PSA score, which a technician earmarked as slightly above the norm for someone my age and race.
Then I got into another line for a digital rectum prostate exam (DRE) conducted in assembly line fashion by an intern. The fellow ahead of me joked that if he passed, he feared they’d draft him into the Army.
When it was my turn, the intern, who studied my PSA result before giving the DRE, said he detected something abnormal and recommended I make an appointment with a urologist. Not what I wanted to hear. On the drive home, I imagined pain in the general vicinity. Or throbbing. Or something.
Skeptical by nature, I purposely avoided any and all urologists associated with the clinic that sponsored the free screening and instead made an appointment with an outsider. As my guy prepared to give his own DRE, he told me that “if my DRE agrees with their intern’s, I do a biopsy today.”
No problem, I thought, recalling a painless biopsy for a mole I had removed. Let’s do it. He administered the exam and said everything was normal.
When I told him I was greatly relieved but distressed about the erroneous test at the clinic, he said DREs are very subjective, depending on the breadth of the doctor’s experience. It made me wonder how many of the other poor schmucks in that line got a misleading result.
As for my so-called elevated PSA number, he explained that false positives can occur for lots of reasons, including the patient going bicycle riding or having intercourse a day or two before blood is taken. Why wasn’t I told that before the free screening?
Just to be certain, my guy recommended another PSA for the following week, a test that rendered a healthy 1.6 level.
Angry, I placed a call to the head of the clinic that sponsored the screening. I told her that I had received a misleading PSA score thanks to their not giving important pre-test information, which led to about $300 in co-pays for two doctor visits and laboratory fees. And that I had been a second opinion away from a biopsy that involves a long and vicious-looking needle being inserted and that often causes bleeding and infection.
“Well, at least you know you don’t have cancer,” she said.
I took a deep breath and counted to 10. I wracked my brain to recall the Latin term for the logical fallacy she had just employed (something about the end justifying the means).
Instead, I told her it seemed the clinic was luring patients with a free screening to drum up business. She protested, asserting that their company had a sterling reputation.
I thought about calling a lawyer. The particular clinic stopped free screenings the following year.
I’m no medical expert, but you can add my vote to those on the Preventive Services Task Force to avoid PSA tests if you have no health problems.
And to not go looking to fix what ain’t broke.
David McGrath, a former resident of Evergreen Park and Oak Forest, is a writer, not a doctor, and emphasizes that you must consult your physician before making such decisions.
