Since when is less information a better basis for making a good decision? I am sure Ian Haines (oncologist) is well-intentioned and speaks for many when he explains why he won’t have the “cancer blood test” commonly known as a PSA test (a simple blood test measuring the amount of prostate-specific-antigen in the bloodstream). He provides four reasons you should not have the test. However, he does not speak for me or for many intelligent men I know. Although much of what he says is true, his conclusion is flawed.
Like Dr. Haines, I too have “skin in the game,” and so I feel compelled to step forward and represent the opposing team. Haines has served up an unhealthy meal of random facts seasoned with his personal fears, all blended together with questionable logic. Let’s throw it up against the wall and see if it sticks.
Imperfect Does Not Mean Worthless
… in light of the fact that there are precious few prostate cancer testing tools at all, should we toss out the ones we do have merely because they are imperfect?Haines’ first reason to avoid the PSA test is that “PSA is a poor testing tool.” He explains why, and I’m willing to concede that PSA is indeed an imperfect diagnostic tool for prostate cancer. But like many imperfect things in life, it still has value. Especially in light of the fact that there are precious few prostate cancer testing tools at all, should we toss out the ones we do have merely because they are imperfect? PSA testing provides one of very few clues about the possibility of prostate cancer. It seems that Haines is more comfortable being clueless than having an imperfect clue to consider.
Early Treatment Can Help
Next, Haines points out—again correctly—that prostate cancer is different than other cancers. The relevant difference is that “in the majority of cases, prostate cancer … does not pose any threat to the patient’s natural life span.” Well, that’s wonderful news unless you are in the not-insignificant minority. The Mayo Clinic says, “Early treatment can help catch the cancer before it becomes life-threatening …” Well, yes! Isn’t that a legitimate goal? Now, how do we get there without a few clues, imperfect or otherwise?
The third reason Dr. Haines offers is that “surgery won’t always cure you.” True. But aside from failing to even mention any other treatment options for prostate cancer—and there are many, including proton radiation which I had in 2011—why is this man so obsessed with guarantees and perfection, or the lack thereof?
… why is this man so obsessed with guarantees and perfection, or the lack thereof?Just for fun, let’s go along with surgery as the only treatment apparently worth mentioning. In a very confusing and mystifying paragraph he says that radical surgery (i.e., removal of the prostate) “cures” six in seven cases. The quotation marks are his, indicating, I suppose, “not really” cured. He goes on to explain that most of those six “did not require treatment.” This bizarre remark is left dangling for his readers to ponder as to what that means. Did they not require treatment because in the Haines Crystal Ball he saw them dying of something else before their cancer would have done them in? Or were they tricked by the super-salesman-surgeon into needlessly going under the knife? Maybe in post-op Haines heard the surgeons say something like, “Darn, really didn’t need to do that one!” Beats me.
As for the other “one in seven” not in the above group, the ones with “dangerous cancers requiring cure,” well, sadly, most “will not be helped by the treatment,” he says. So what is Haines suggesting by implication? If you’re one of his six not needing treatment, wait in blissful ignorance until you’ve become the unfortunate seventh for whom it’s usually too late? What kind of logic is that?
What especially troubles me about Haines’ six-in-seven or one-in-seven is that he makes no comment regarding men not in his “most” groups. We must assume that they did require treatment and very possibly were helped. But too bad for them; they were in the Haines-Minorities.
Life is Risky; PSA Tests are Not
Dr. Ian Haines’ fourth and final reason for not having a PSA test is perhaps the most revealing one. He once again accurately states that “one in six men will be diagnosed with prostate cancer” and that their “lives will be profoundly changed.” Right on, Ian. Then the curtain rises, and he presents a laundry list of his personal fears.
Here is a summarized list of what Ian Haines fears and explicitly does not want: anxiety, depression, relationship changes, impotence, urinary incontinence, or the 1-2% risk of infections caused by prostate biopsies. Fair enough. I did not and still don’t want those, either. Surprisingly, after listing these horrors, Haines does not actually blame them on or tie them to PSA testing. He just jumps ahead to his flawed conclusion, hoping we will join him in blindly regarding the PSA test as a Pandora’s Box of Prostate Peril that should be left locked to protect us.
PSA Tests are Not Omnipotent
The PSA test result is nothing more and nothing less than a clue about the possible existence of prostate cancer. Where is the harm in letting each man decide …Haines’ “bottom line” and biggest fear is having his life “ruled by a regular blood test like PSA that has no advantage.” No advantage? The advantage is simple and obvious: it provides information. The PSA test does not cause any of the Haines Hit List of Horrors. The PSA test is benign. It is not cancer. It is not a biopsy. It is not surgery. It does not rule lives. It is merely information that is easily obtained along with your cholesterol levels and other possibly useful data about your health.
The PSA test result is nothing more and nothing less than a clue about the possible existence of prostate cancer or other prostate-related conditions. Where is the harm in letting each man decide whether he wants that clue, and how to utilize the imperfect information it provides? We live with imperfection every day. We make decisions of all kinds based on less than ideal data. If a man does not want that information, that’s fine with me. If I played golf I would still be happy to hit the links with a man who doesn’t want a PSA test. That is, as long as he does not presume to tell me whether I should have one, and whether I can use the information as I see fit.
For some, ignorance is bliss. For others, information is empowering.Before he offers his four reasons, Haines sets the stage for his editorial by mentioning that “only” 3% of men die because of prostate cancer. The American Cancer Society reports that prostate cancer is the second leading cause of cancer death in American men, and predicts that over 29,000 men will die of prostate cancer in 2014. That might be 3% of men, and it might be some other percent—I really don’t care. I just don’t want to be one of them, and if I am to do my best to stay out of that group I need information.
For some, ignorance is bliss. For others, information is empowering. When it comes to having the PSA test, I would not presume to tell any man including Ian Haines whether he would be most comfortable in the former group or the latter.
How do you feel about this controversial topic? Let me know!