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.

Dr Peter Adams
Dr Peter Adams
Dr Jerry Bruce Emtage
Dr Jerry 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.

4 Responses to Prostate screening debate continues

  1. Rawle Maycock February 4, 2015 at 8:51 am

    The only pros an cons is you men out there go get yours.

  2. Elridge Dixon February 4, 2015 at 3:43 pm

    The key question here is ” Who are the experts?” In other words, who sees and treats men with prostate cancer. Unless there has been a dramatic change in research, all the data points to Black men being at a greater risk than other races.

  3. Barbadian male February 5, 2015 at 7:39 am

    Will the family practitioners please tell us what’s the alternative to the PSA screening….

  4. Dr. Joseph Herbert February 6, 2015 at 8:30 am

    The problem with PSA is that big research studies have failed to show that it saves many lives when used for screening – 1000 men need to be tested every year for 13 years to save one mans life. What these studies show is that men screened with PSA are much more likely to suffer from unnecessary testing & treatment, along with their side effects. These studies were done in Caucasian populations so it is possible the PSA may be more helpful in our population, but without a study in black men, no one really knows.

    Unfortunately, there is no better alternative to PSA screening as yet (though PSA may be combined with the digital rectal exam).
    The alternative is to choose not to be screened, and only have a PSA test if you develop problems with urination or low back pain – cancer will not be found early, but you will avoid the known harms of PSA testing. Until a better way of screening is developed, men deserve to be told of the pros and cons of both options, and should be allowed to choose for themselves which option (screening or no screening) suits them best.


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