The test of time


Now that I'm approaching 50, I'm like most men my age: confused. Should I get a prostate-specific antigen (PSA) screening test? The U.S. Preventive Services Task Force recently finalized its decision to discourage the use of PSA testing as a means of detecting prostate cancer. And although the American Urological Association and the National Comprehensive Cancer Network recommend that men start being screened for prostate cancer at age 40, I know that after age 50, the chance of actually getting prostate cancer increases substantially. The 80/80 principle

Let's face facts: For most men, prostate cancer is almost an inevitability. I spoke to a cancer researcher from Pennsylvania at this year's American Society of Clinical Oncology meeting who said the media doesn't often report on what most oncologists know--that 80 percent of men who reach age 80 will have prostate cancer. They'll likely die of something else before the generally slow-growing tumor metastasizes. So what does a man do, then, if he's an active 81-year-old, like billionaire investor Warren Buffet? Opt for aggressive treatment, with its potentially debilitating side effects, or choose active surveillance? Tip of the iceberg

A PSA test wouldn't be my first exposure to prostate cancer screening. I've been having the digital rectal exam (DRE) as part of my annual checkup for a few years now. (For the unenlightened, the DRE is a less than pleasant experience, one that I refer to as the "cold jelly" exam. As part of my annual physical, my doctor inserts a gloved, lubricated finger into my rectum to feel the surface of my prostate. Just before commencing with the DRE, he announces, "cold jelly!" with the same urgency that I'm sure Frederick Fleet used to warn the officers on the bridge of Titanic that there was an "Iceberg, right ahead!") And there's certainly no danger in getting a PSA test--it requires nothing more than a simple blood draw. So why all the fuss?Ratcheting down the rhetoric

Prostate cancer is the second leading cause of cancer death in men. There's no denying that the death rate from prostate cancer has declined--by 44 percent in the last 20 years. Survival rates over the same period have nearly doubled, from 53 to 98 percent. Can this be attributed to PSA screening alone? Or might it have something to do with increased awareness? Or with more men having serious discussions with their doctors about a cancer that, at one time, was rarely talked about? The only tool we've got

The other day, as I was standing in line at the supermarket checkout, the young cashier asked me if I wanted to donate $1 to help find a cure for prostate cancer. I would rather donate $1 to find a better diagnostic test. The PSA test is fraught with problems. Any number of anomalies could account for the result. But for now, it's the only tool available. We simply don't have any other reliable way to distinguish between men who have indolent and aggressive cancer.So, I guess I'll roll up my sleeve and get the test. If my results warrant a conversation, I'm confident that my doctor will help me understand the risks and benefits involved. One thing in my favor is that I don't have a history of prostate cancer in my family, so a high score wouldn't necessarily mean I should risk getting a biopsy, but that I should establish a baseline and test again at a later date.A cure at any cost

We live in a "cure it if you can" culture, which means people who have the means to do so (and many who don't) will insist on going to extremes to cure an illness--especially cancer--if it can be cured. But when it comes to prostate cancer, the cure is sometimes worse than the disease. That's a risk I'm not yet willing to take.

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