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Patients, Doctors Face Tough Questions Amid Changes in Prostate Cancer Screening

October 20, 2011 at 12:00 AM EDT
There have been plenty of questions and reactions in the medical community since a government panel recommended changing the way men are screened for prostate cancer. Health correspondent Betty Ann Bowser reports on some of the responses among patients and doctors.
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MARGARET WARNER: Finally tonight, there have been lots of reactions and questions raised about a government panel’s recent recommendation to change the way men are screened for prostate cancer.

NewsHour health correspondent Betty Ann Bowser has been sampling some of the responses among patients and doctors.

BETTY ANN BOWSER: Sixty-five-year-old Terry Dyroff and his wife, Patricia, can’t forget what happened four years ago, shortly after he underwent a biopsy for prostate cancer. The retired professor had the procedure after a PSA test showed high levels of protein being released from his prostate gland, a possible indication of cancer.

TERRY DYROFF, suffered septic shock: We were told to give the office a call if there were — you know, developed a fever. I had my wife call them, but she couldn’t get them right away. And I would guess, within 15 minutes, I said, forget trying to reach somebody. You have just got to get me to the emergency room. This is — I have never experienced anything like this.

So it came on very, very quickly. I was in septic shock. And I didn’t know at the time how dangerous that was.

BETTY ANN BOWSER: The infection was rare, Dyroff recovered. But it’s those kinds of complications connected with the testing that have stirred controversy around a new government recommendation on the test, which is now routinely given to men over 50.

Prostate cancer is a slow-growing disease that usually doesn’t progress outside of the prostate gland. But many urologists point to research that clearly shows that the death rate for prostate cancer has dropped dramatically, a disease that strikes one in six men.

But earlier this month, an influential government panel recommended that healthy men shouldn’t be routinely tested. The U.S. Preventive Services Task Force said the PSA test causes more harm than good, often triggering a series of unnecessary biopsies, surgeries and radiation. The report found 95 percent of men with PSA-detected cancer who were followed for 12 years did not die from that cancer, even without treatment.

DR. MICHAEL BARRY, Foundation for Informed Medical Decision Making: The PSA test may seem like a simple blood test. The issue is what happens afterwards.

BETTY ANN BOWSER: Dr. Michael Barry is the president of the nonprofit Foundation for Informed Medical Decision Making and a primary care physician at Massachusetts General Hospital in Boston.

The risks include infections like Dyroff’s and treatments that can leave men incontinent or impotent.

DR. MICHAEL BARRY: Many men, of course, would say that in order to beat prostate cancer, it’s worth putting up with those side effects. Unfortunately, we know that many of those men would have been treated for cancers not destined to cause future problems.

But we can’t tell which ones, and sometimes any man who has been treated would think he was the one who’s life has been saved by this test, and the side effects would be worthwhile.

BETTY ANN BOWSER: More than 217,000 American men were diagnosed with the disease last year — 32,000 died from it.

Like the majority of urologists, Dr. John Lynch disagrees with the task force findings. He’s chairman of the Urology Department at Georgetown University in Washington, D.C., and a board member of the American Urological Association.

DR. JOHN LYNCH, Georgetown University Hospital: Prostate cancer is the second leading cause of male cancer deaths today, even with the PSA test. It’s not a 100 percent accurate test, but it’s the best that we have and the only test that we have.

BETTY ANN BOWSER: Dr. Lynch, a prostate cancer survivor himself, is concerned that the report will encourage men to stop being tested, and more men will die.

DR. JOHN LYNCH: Before PSA tests, about two-thirds of the patents that I saw who had the diagnosis of prostate cancer made had advanced prostate cancer. I don’t want to go back to that time. Most of the men today are — have early disease that’s treatable and curable.

BETTY ANN BOWSER: Ronald Baum is one of Dr. Lynch’s patients. He recently underwent surgery for prostate cancer.

RONALD BAUM, prostate cancer sufferer: I had no problems. I have had PSA readings for the past 10 years. I have no objections to it. And my feeling is, it buys you piece of mind. My feeling is that the PSA reading at least gives you some sight — insight of whether or not anything is forming inside your body.

BETTY ANN BOWSER: Dr. Lynch hopes others will continue getting tested, though he acknowledged the task force findings have caused some confusion among his patients.

DR. JOHN LYNCH: Some patients in the last week have expressed some confusion. I have not had any patient refuse to get a PSA check or tell me they don’t want their PSA checked.

Not every prostate cancer, again, needs to be treated, but many of them do, and then it gets into the treatment decisions, which is the best treatment for that particular patient. There are complications from every treatment. But do the benefits outweigh the risks? That’s the big question. And that depends on the type of cancer.

BETTY ANN BOWSER: But for some men like Terry Dyroff, the decision has already been made. Although there’s a history of prostate cancer in his family, after careful consideration, he’s decided to forgo future PSA tests.

TERRY DYROFF: It doesn’t really save lives. There are too many false readings. And a lot of times, as in my case, you can have complications from the biopsy that are worse than anything you might have otherwise.

BETTY ANN BOWSER: Dr. Barry said that may not be true for all patients and each needs to decide what to do about PSA testing for themselves.

DR. MICHAEL BARRY: More men need to have a big role in deciding whether the PSA test is right for them, rather than having an expert panel, whether from the U.S. Preventive Services Task Force or the American Urological Association, saying one size fits all for all men. Men should be informed about the potential, albeit uncertain benefits and the potential for side effects, and work with their clinicians to make a decision of what’s right for them.

BETTY ANN BOWSER: The draft recommendation is open to public comment until Nov. 8.