Is there a time when knowing what’s going on with your body is counterproductive?
The U.S. Preventative Services Task Force, which in 2009 said that mammograms weren’t necessary for women under 50, is recommending that men skip routine prostate cancer screenings in a guideline published Monday.
As with its recommendation that women 50-74 should get biannual breast cancer screenings — a sharp departure from annual exams starting at age 40 for women that other medical groups recommend — this change in how much you need to know and when you need to know it for men is unsettling to some, including many urologists.
The task force argues that there not enough evidence that the tests, commonly known as PSAs for the prostate-specific antigen they detect, save lives, while the treatment of tiny tumors that would never have been fatal to a male patient leads to too many cases of impotence, incontinence, heart attacks and occasionally death. The PSA test also isn’t a foolproof indicator of cancer, since enlarged prostates and infections can cause a positive reading.
Health numbers show that about a quarter-million American men are diagnosed with prostate cancer each year, with most of the cases involving slow-growth tumors that are unlikely to turn into aggressive ones.
While it may be true that the best course of action in certain cases of prostate cancer would be to do nothing, we fail to see why any man should purposely choose to remain ignorant of what is going on inside his body. Knowledge can be unsettling, but that decision — and the decision as to whether to conduct the test to start with — should lie completely between the patient and a doctor that he trusts.
Fortunately, it appears that this recommendation won’t have much more real effect than the breast cancer screening guideline the task force issued. The Obama administration said Monday that Medicare will continue to pay for PSA tests, which is usually the benchmark insurers use in determining what they will cover.
When comes to dealing with some stress over a test result or not having a test and failing to catch a cancer that is aggressive, we’d prefer the stress. Perhaps one day the PSA blood tests will be so refined that the physician can tell whether a particular detection of prostate is a life-threatening one, but until that happens we believe the best course of action is the one that yields the most knowledge for the patient. If a patient learns he has prostate cancer, then he and his doctor can determine the risks and benefits of treating the tumor. They may decide to take action immediately or to closely monitor the tumor and delay treatment until it shows signs of growth.
And that, we believe, is where the decision — a fully informed one — should always be made.