When Screening for a Male-Only Cancer Can Cause Real Problems

A recent surgical procedure to correct an irritating and common condition in older men caused me to ponder on the following question: 

More screening for more cancers is a good thing, if it leads to earlier interventions which then help save more lives?

Yes, unless you are talking about prostate cancer as a major study out this week has revealed yet again.

 The irony is that widespread detection of what might eventually turn out only to be dormant cancers in that tiny internal male organ can cause no end of harm and hurt.

In other words, the negatives caused by prostate cancer over-diagnosis, such as surgery and radio-therapy, can in aggregate outweigh the positives.

It sounds counter-intuitive and the rationale takes a little time to explain but stay with me as if you are a man, or a partner of one, it’s important.

As the small ads you may have seen in the men’s toilets in airports remind us: more men die of prostate cancer each year (3,100) than women do of breast cancer.

The Australian Institute of Health and Welfare say it is the second leading cause of death in Australian males with 17,000 cases diagnosed each year.

But this story is about those who may be screened by the common test for the disease and found to have an elevated PSA or prostate-specific antigen in their blood.

The Bond University study shows Australia is no different from other comparable countries in terms of the 40% of such cancers detected which are over-diagnosed and can lead to unnecessary treatment. (see report here)

The lead author, Dr Thanya Pathirana, said the adverse effect of widespread screening, such as the PSA test, was the detection of harmless dormant cancers and their subsequent treatment.

“What we know about over-diagnosis is it can lead to unnecessary and, in some cases, harmful procedures and treatments such as prostate surgery, radiotherapy and hormone therapy,” she is quoted saying.

“In the case of prostate cancer, this can also include a prostatectomy (removal of the prostate gland), which can cause incontinence or impotence.”

I am interested in this subject for two reasons. I just recovered from surgery following a common and non-cancerous prostate condition. The curious can find all the gory details here under TURP, the Transurethral resection of the prostate.

 The second is that a five years ago I was on a citizens’ jury at the University of Sydney which was asked to rule the following question: “What should happen before asymptomatic men decide whether or not to have a PSA test?” 

Such ‘juries’ are a non-binding tool to used in this case to see how three different groups would absorb the information around this controversial area and then decide on how much, or little, GPs should tell their patients ahead of the test.

Again, you can find out more about the complexity which makes this such a contested area. Just read the introduction here to learn some useful background expressed fairly simply.

So what to do? I recall our jury wanted GPs to give specific advice about the pros and cons of PSA testing before it was undertaken not withstanding this would take time. 

The last word should go the study’s co-author Professor Paul Glasziou of the University of Sydney who says men without symptoms should ensure they talk with their GP about the risks and potential benefits of screening. “Don’t get me wrong - men still need to remain vigilant when it comes to early detection, however they need to be informed and engage in shared decision making with their medical professionals about the harms of prostate cancer screening and other associated procedures,” he said.

The great debate on how best or little to test for prostate cancer will continue but in the meantime, men and their partners might find out more about this condition and the best way to deal with it.