Dollars for Donuts

Image via Wikipedia

Those crazy Brits. It seems that health authorities in the United Kingdom recommended against using the PSA (prostatic specific antigen) blood test to screen for prostate cancer. The UK National Screening Committee began looking at the results of several major studies and determined that the blood test generated more false positives—the test suggesting cancer, when another cause was found—and caused more angst for physician and patient’s then actually saved lives. It’s true that a benign enlargement of the prostate (the donut–shaped gland that surrounds the male urethra), or urinary tract infection can also cause a high PSA. The committee formulated the doctrine of ‘informed choice’: explaining to patients the pros and con of PSA screening and allow the patient to decide if he wants to have the test.

Critics suggest a similar approach here in the US. However, American men have become used to the constant message of early and frequent PSA screening. We know that British authorities often chose a course of action that saves the British government money at the cost of providing adequate health care to their population, or so it seems. We’re bombarded with stories of men whose prostate cancer would have remained hidden and deadly, if not for the fortunate result of a PSA test.

Now, to make matters even more confusing, it seems that treatment of American men with prostate cancer may also be driven by money. The Wall Street Journal reported a finding that one out of three men with prostate cancer received treated by radiation—a specific form of radiation called IMRT—that just happens on occasion to be owned by the same physician’s (urologists) recommending the therapy. This self–referral by urologists to IMRT centers that they happen to own is not illegal and urologists would argue it allows them to give prompt care to patient’s that need it. A course of treatment isn’t cheap (up to $40,000 in some states) and urologists might argue it has less side effects than surgery.

All of this adds to the conundrum of what to do about and for prostate cancer. The best advice for now is to discuss this with your physician and be open to the suggestion about doing nothing in terms of PSA screening . After all, its quality of life we’re after and all treatments have potential side effects. So let’s be sure we know exactly what we’re getting into and that any recommendations are for treating the whole patient—not the whole wallet.

Related Articles

• Prostate screening ‘unadvisable’ (bbc.co.uk)
• Prostate screening for the over-50s is ruled out as ‘harm outweighs the benefits’ (dailymail.co.uk)
• PSA Test Reduces Risk of Spread If Prostate Cancer Strikes (nlm.nih.gov)
• A Device to Kill Cancer, Lift Revenue (online.wsj.com)