Urologist defends PSA testing in Barbados
A leading urologist has dismissed concerns by a group of medical practitioners that prostate cancer tests being offered in Barbados could cause more harm than good, saying the evidence they have relied on in their argument is not relevant to black Caribbean people.
Dr Jerry Emtage of Barbados Urology, and his son Dr Justin Emtage, told Barbados TODAY that while they were not promoting mass screenings, “we should not go back to the Dark Ages where the young and middle-aged black men present with cancer that has spread and the only option for treatment available to them is palliative”.
“The incidence in the black male is three times that of the Chinese male, two-three times that of the Caucasian/Indian male. Often times these three groups have absolutely no first-hand experience of a family member with this disease. We all do! We have friends and family stricken by this disease. We cannot extrapolate from a Canadian or North American experience; we have to find our own,” they insisted.
The elder Emtage said recent data, soon to be published by his centre, shows the rate of prostate cancer in Barbados may be as high as 115 out of every 100,000– “one of the highest in the world” – and early diagnosis was therefore crucial.
Last November, four family physicians –Dr Peter Adams, Dr Colin Alert, Dr Joseph Herbert and Dr Malcolm Howitt – outlined their case against the prostate specific antigen (PSA) test in a letter to Barbados TODAY.
They questioned why officials were promoting the PSA test without full discussion on its benefits and harms, noting that while the screening can detect prostate cancer, “the available evidence suggests that very few lives are saved, and screening often leads to unnecessary testing and treatment”.
They made reference to the United States Preventative Services Task Force and the Canadian Task Force On Preventative Health Care that do not recommend prostate screening. The doctors added that a report published last October by that Canadian task force had indicated that if 1,000 men from the general population were screened for 13 years using the PSA test, four of the 178 with a positive result 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.
However, the urologists insisted the American national task force’s guidelines referred to individuals with low risk while the Canadian task force referred exclusively to the white male population, “and therefore has no reference or basis for the black Caribbean or African-American male”.
“If you are a black male over 40, you are at high risk. No one has ever suggested that PSA testing should be used for mass screening,” they argued in a statement responding to the physicians.
The urologists also suggested that because the general practitioners were not on the frontline of treating the disease they did not see the big picture.
“They do not deal directly with patients who are confronted with the futility of metastatic (spread) prostate cancer and the great expense required [for] treating it,” they wrote.
“Current medications for individuals with hormone refractory prostate cancer – cancer no longer responding to current medications – . . . can cost anywhere between $15,000 to $20,000 a month. Provenge can run to almost US$90,000 a month. How many in our population can afford this treatment cost? It is therefore cheaper to find these individuals early rather than late.”