DEAR DR. ROACH: I read your recent column concerning the fellow who was reluctant to go to a doctor regarding his prostate. I'm very curious why the PSA is now considered a legitimate test for prostate problems.
I distinctly recall a discussion on the radio with a doctor about 25 or 30 years ago, in which it was carefully explained why the PSA is of little value and is not worth doing. Do you remember that time? I'm wondering if it was the insurance companies that were behind that policy. — F.
B. A: I remember that time very well. The change does not have to do with insurance companies, but through a better understanding of how best to manage low-risk prostate cancer.
Most prostate cancer found at screening (meaning men with no symptoms) is low-risk. Many times, both men and their physicians insisted on definitive treatment for even low-risk prostate cancer when it was found through screening. That meant many men getting surgery, with its attendant high risks of sexual dysfunction and urinary incontinence, as well as a small risk of life-threatening complications.
A review of the risks and benefits for prostate cancer screening as a whole found that the risks (including the many men who got complications) outweighed the benefits, and some (but not all) experts recommended against prostate cancer screening. While this prevented many complications from surgery, it also had the effect of preventing many men from being screened and, therefore, coming to medical attention only wh.