Map of life expectancy at birth from Global Education Project.

Friday, September 17, 2010

I'm not a real doctor . . .

I'm a doctor of philosophy. As Dr. Ruth used to say, "I cannot advise" (although, oddly, giving advice was the entire reason for her existence). Anyhow . . .

The Brits tend to be considerably more clear-eyed than we are about the relative good and bad of doing medical type stuff, so leave it to BMJ to publish this meta-analysis from U.S. based researchers on prostate cancer screening. The money shot:

Screening was associated with an increased probability of receiving a diagnosis of prostate cancer (relative risk 1.46, 95% confidence interval 1.21 to 1.77; P less than 0.001) and stage I prostate cancer (1.95, 1.22 to 3.13; P=0.005). There was no significant effect of screening on death from prostate cancer (0.88, 0.71 to 1.09; P=0.25) or overall mortality (0.99, 0.97 to 1.01; P=0.44). All trials had one or more substantial methodological limitations. None provided data on the effects of screening on participants’ quality of life. Little information was provided about potential harms associated with screening.

Conclusions: The existing evidence from randomised controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination.

So here's what happens if decide to undergo prostate cancer screening:

1. The doctor may stick his finger up your ass. You may or may not like that.
2. You may be diagnosed with "prostate cancer."
3. You may spend time in a hospital, spending a lot of your own or other people's money, and undergo surgery or get yourself heavily irradiated "down there."
4. You may end up incontinent of urine, and unable to sustain an erection.
5. There is no reason to believe that you will live even a single day longer than you would had you not done all this.

So, make your own decision.

Note: As usual, if you have a family history, or if you are of African descent, or for whatever reason are at higher than usual risk, you may have a different calculation. You should talk with your doctor, but I warn you, they tend to be all for doing this, because that's just how they are. Also the urological, radiological and surgical societies won't like me for telling you this.

In the future, we hope, doctors will get better at distinguishing between dangerous and not so dangerous prostate tumors. When that day comes, all will be different.


roger said...

bonus of colon scan showed no cancer anywhere, presumably including prostate.

don't point that finger at me doc.

updated from earlier deleted comment: is this situation part of the problem of fees for tests and services instead of for general healthcare?

Cervantes said...

Short answer: Yes, to some extent it is. There is also a cultural bias toward action.

As Roger well knows, just because the calculus makes one screening test look questionable, that doesn't extend to all of them. I have consistently supported screening colonoscopy here, and I don't know if that had any influence on Roger's choice but I hope his experience will encourage others to do it. It's not the most pleasant thing to go through but it beats not doing it.

kathy a. said...

just to be clear -- you are talking about routine "you are this age" screening, rather than testing when there are some possible symptoms, and/or if there is a family history?

Cervantes said...

Certainly. Screening is to be distinguished from diagnosis. Population screening means everybody of a certain age gets the test. Diagnosis means there is some specific reason for concern and we are trying to explain symptoms.

Family history may change the calculus for screening, also.