Flawed test for prostate cancer is better than none

April 02, 2002|By Ralph Burnett

THE RECENT debate over early detection of prostate cancer rekindles the words of Winston Churchill during World War II: "Action in pursuit of perfection equals paralysis."

Prostate cancer is the most commonly diagnosed malignancy in American men; two every five minutes in this country are told they have it, and more than 30,000 will die from it this year alone.

Millions of men and their families have already been devastated by prostate cancer. That's why millions of others don't need another excuse to avoid taking care of their health.

But the argument against the use of the test for detecting PSA, or prostate specific antigens, in connection with prostate cancer has been giving that excuse.

Worse yet, it is persuading some doctors to sit on results of a high PSA count and causing others not to offer a test to their patients. A slight increase in PSA levels is said to show that there is a problem.

This dangerous new practice flies in the face of the many who would have benefited and perhaps lived had their cancer been discovered earlier. Speaking from experience, the risks of having prostate cancer far outweigh any risks attached to any testing procedure.

Despite the PSA test's imperfect tendencies, prostate cancer deaths have decreased more than 27 percent in the last five years, in part because of the PSA test. Before it, nearly three out of four men diagnosed with prostate cancer were in the late stages of the disease -- a point at which prostate cancer is neither readily treatable nor curable. The advent of screening has caused a 180-degree turnaround in that statistic, giving men a fighting chance against the disease.

There is no doubt that more research is needed toward finding a better model for early detection and prevention.

But if doctors and clinicians put off the decision of using PSA tests until science discovers that blueprint, lawmakers and lawyers may make that decision for them.

There is already precedent of that occurring. A federal court in Vermont, in Short vs. U.S., determined that a patient presenting "substantial urological symptoms should have been referred to a urologist ... or [given] a PSA test." Since the Vermont case, there has been a growing number of plaintiff verdicts against physicians who failed to act according to guidelines.

The PAP smear has saved the lives of countless women since it was introduced -- without any prior clinical trials to prove its efficacy, creating upheaval, outrage and activism in the patient and advocacy community in the process. The PSA is effectuating similar results.

Men over the age of 50, younger if African-American, a veteran exposed to Agent Orange -- like myself -- or one with a family history of the disease, should put aside the excuses and be tested annually. I'm glad I did.

It has saved my life.

Ralph Burnett is a Maryland district court judge and a board member and former chairman of the National Prostate Cancer Coalition. He continues to successfully fight prostate cancer.

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