Prostate screening debate continues
Medical practitioners in Barbados continue to debate the pros and cons of prostate screening.
Four family physicians who expressed concern about the prostate specific antigen (PSA) test last year, are holding to their position that men should know both the benefits and disadvantages of screening.
The insistence by Dr Peter Adams, Dr Colin Alert, Dr Joseph Herbert and Dr Malcolm Howitt, follows arguments in support of PSA screening by urologists Dr Jerry Bruce Emtage of Barbados Urology and son Dr Justin Bruce Emtage.
The Emtages posited that while they do not recommend mass screenings, the test was useful.
But in rebuttal, the family physicians said while organizations such as the American Urology Association still favour offering screening to selected men, other expert groups believe that it does more harm than good.
They pointed out that the US Preventative Services Task Force recommended against prostate cancer screening in the “general US population” in 2012, while just last year, the Canadian Task Force on Preventative Health Care also recommended against prostate screening in “all men”.
“We wish to clarify that these recommendations were not limited to only Caucasian men, but for all men,” the group stated.
They also dismissed the suggestion that PSA screening would be more beneficial in Barbados simply because prostate cancer is more common and more aggressive in black men.
“This assumption may be intuitive, and while there is a possibility that it may be true, it is unfortunately unscientific and not supported by good quality evidence,” they said, while making reference to the guidelines of the US Preventative Services Task Force.
That organization said, in part, that “no firm conclusions can be made about the balance of benefits and harms of PSA-based screening . . . However, it is problematic to selectively recommend PSA-based screening for black men in the absence of data that support a more favourable balance of risks and benefits . . .”
The local doctors maintained that many men would suffer from problems such as anxiety, infection, incontinence and impotence due to unnecessary treatment and testing, adding that “many more will suffer from anxiety due to false-positive tests”.
“It is a great tragedy that we have not discovered a more effective screening test as yet, but as the Emtages pointed out, new [and potentially better) approaches are emerging. Until a better approach is developed, doctors must ensure that men are made aware of not only the potential benefits of prostate cancer screening, but also the potential harms and uncertainties. Every man’s right to make a fully informed and independent decision must be respected,” the family physicians added.