On the topic of unnecessary screenings, a recent personal vignette in the Archives of Internal Medicine explores the issue of overuse of PSA testing for prostate cancer from a deeply personal perspective. Dr. Charles Bennett, an oncologist who specializes in prostate cancer, tells the story of his own experience with PSA testing, as well as his regrets about this screening and the consequences that followed.
Dr. Bennett found that, after deciding to receive routine annual PSA screening following his 50th birthday, his PSA levels increased in a worrying way. A biopsy then found that there was indeed cancer. So Dr. Bennett did the same as most of his patients would do: After receiving some second opinions, he decided to undergo a prostatectomy with a highly respected surgeon, convinced that any complications would be minimal, and that this would ensure the best outcome.
Yet Dr. Bennett s surgery resulted in some serious complications, and while he remains prostate-cancer free, he regrets having chosen surgery. If given another chance, he says, he would choose active surveillance of the cancer instead many instances of prostate cancer would not harm the patient even if left alone.
ACSH's Dr. Elizabeth Whelan notes that this is an important illustration of the complex dilemmas that patients and even highly expert doctors face when making decisions about PSAs and prostate cancer. The difficulty with PSAs, she says, is that they catch a lot of people who don t actually have a problem that needs to be addressed. Then they end up getting unnecessary surgery and the complications that go along with it. Men without risk factors need to think twice before getting a PSA test. If an abnormal result comes back, there is still the question of what if any action to take. Obtaining an abnormal result does not necessarily indicate a real problem, yet can cause a lot of unnecessary anxiety.
