I have prostate cancer. I have heard from all the experts and now I would like to offer my opinion, a patients perspective, about the U.S. Preventative Services Task Forces recent recommendation that routine PSA (prostate specific antigen) testing should be abandoned for most men.
I am 65 and was diagnosed with prostate cancer in January 2005 after getting a PSA of 5.5 during my annual physical. A subsequent biopsy reflected that I had a Gleason score of 7 (4+3). Doctors told me I had intermediate- to high risk-cancer with bi-lateral, high-volume disease. The initial urologist painted a much too rosy post operative prognosis and wanted me to allow him to perform a prostatectomy immediately.
I chose instead to investigate on my own, researched using the Internet and received the opinions of a multi-disciplinary team of urological specialists at another practice. All the urologists, despite the disparate prognoses, recommended radical treatment.
I chose what was then called watchful waiting and now often referred to as active surveillance. This includes getting quarterly PSA tests to check the velocity of possible PSA elevation, periodic ultrasounds and biopsies. In addition, I use a lower-fat diet, exercise, capsaicin, d-Gamma Tocopherol as well as daily Finasteride.
Let me explain why I did not follow my urologists directions. First, I respectfully challenged the premise that surgery would save my life. No doctor can save my life. They can only extend it. I learned that prostate cancer is generally slow growing and what a man should factor into his decision is the marginal risk of death due to the cancer, not the absolute risk. The question should be statistically what is the cost to me in months or years of my life. That answer is quite different.
Second, I took into consideration my quality of life. Although my first urologist said the chances of impotency and incontinence were very minor, subsequent doctors, looking at the same data, said the opposite, that the disease would have to be treated aggressively, virtually assuring a lifetime of troubles presented above. I even learned that the Partin table (a nomogram used to counsel individual patients and help them make important decisions regarding their disease based upon their factors) revealed that there was only a 40 percent chance my cancer was prostate gland-confined to begin with, so there was a 60 percent chance of metastasis already. So if the cancer had spread surgical removal would not help at all.
Third, I just wanted the decision to be mine. I told no one except my wife and children and a handful of close friends. I had lost a brother to a different type cancer five years earlier and I did not want the burden on my parents, so I kept this from them for the rest of their lives. I had also just started my first term in the state Senate and did not want any publicity, although in 2007 I sponsored and passed Senate Bill 3, Prostate Cancer Awareness, creating a prostate cancer license tag. Surprisingly, only one person ever asked why I created the legislation.
So I have a resolution. I do not agree with any position I have read in the weeks after the Task Forces recommendation. I do not agree with its suggestion to abandon the PSA tests nor do I agree with the American Urological Associations lack of action over the years in addressing the fact that most men undergo radical treatment upon learning they have this cancer, while data suggest overtreatment.
I suggest an alternative. The PSA screenings should continue. I want to know if I have cancer! What is done about it is a different and mutually exclusive issue. However, I suggest that a mandatory, data-driven Statement of Risks, including an independent interpretation, be given a patient and precede any radical prostate removal or irradiation. This statement should cover the risks of not being treated, the risks of radical treatment, plus statistical outcomes based upon all the alternatives.
This is a prudent solution compared to the polarity of men not even knowing when they have the cancer and men being overtreated for the disease. Certainly those men who have a family history of prostate cancer and all African-American males should disregard all this discourse and make sure they are screened, because of elevated risk.
For the rest of us, I think the solution to the task force versus the physicians position lies in the middle. Screen us, tell us the results, educate us, and allow us and our families to make the best choices for ourselves.
Eddie Goodall, of Weddington, is executive director of the N.C. Public Charter Schools Association and a former state senator.