Men at risk
Doctors concerned prostate screening may do more harm than good
Four medical practitioners have raised concerns about the method of prostate screening used in Barbados, saying it may do more harm than good. In a joint letter today to Barbados TODAY, family physicians Dr Peter Adams, Dr Colin Alert, Dr Joseph Herbert and Dr Malcolm Howitt questioned why officials were promoting the prostate specific antigen test (PSA) without full discussion on its benefits and harms.
“While the test currently used –– the prostate specific antigen (PSA) –– can detect prostate cancer, the available evidence suggests that very few lives are saved, and screening often leads to unnecessary testing and treatment,” they said, while noting that no better screening test had yet been developed.
“. . . The United States Preventative Services Task Force and the Canadian Task Force On Preventative Health Care, both well respected government-funded institutions do not recommend prostate screening,” they stated.
The physicians added that in a report published last month that Canadian task force had said that if 1,000 men from the general population were screened for 13 years using the PSA test, many of them would suffer some degree of anxiety after the initial tests had suggested the possibility of cancer, and that four of these 178 with a positive PSA would experience biopsy complications, such as infection and bleeding severe enough to require hospitalization.
The study, the doctors said, also found that while 63 men would benefit from treatment, their outcome would not have differed if they had never had PSA testing.
“Other organizations that still recommend prostate cancer screening emphasize that men should be made aware of the associated harms and benefits up front; each individual man should then be allowed to decide whether or not screening is best for him,” the doctors pointed out.
They say the only reliable statistics estimate that 1,000 men need to be screened and exposed to the previously potential harms in order to save a single man’s life.
The physicians added: “We strongly believe that Barbadians have the right to be fully informed of the associated harms, benefits and uncertainties before prostate cancer screening is offered or recommended.”
Chief Medical Officer Dr Joy St John has deferred comment on the matter. However, one official in the Ministry of Health was upset with the claims by the local doctors stating “screening is not perfect, but it is a very good way to pick up things”.
At a prostate screening exercise in late August, another family physician, Dr Sean Russell, made a case for men taking the PSA test as early as at 35, and every year thereafter.
“Based on my own experience with my regular patients who will come for their medicals and once a year for their full check-up, I would do the PSA. That one year is normal; and the next year it is not normal. And sometimes when it is not normal, it is prostate cancer.
“So if they decide to skip two or three years, when they do decide to turn up it may be too late; it may have advanced to a stage where you couldn’t get proper treatment. So the idea is to do it annually,” Russell said.
Please see full letter from doctors on Page 16 of the November 24th Barbados Today ePaper edition – http://epaper.barbadostoday.bb.