COLUMN – Benefits of that early PSA
Professor Richard Wassersug, 68, is a champion for early screening to detect cancer, because he has lived with the dreaded disease.
Sixteen years ago, he was diagnosed with prostate cancer; but after successful treatment, he is a proud survivor focused on helping patients and families adapt to the side effects of cancer treatment.
“I was diagnosed at the age of 52. I had a PSA [prostate specific antigen] test, which came back saying I indeed had prostate cancer. I had surgery to remove my prostate, which was cancerous; but my PSA kept climbing, which meant there were still cancer cells in my body.
“I then had radiation. My PSA still kept climbing . . . [The cancer cells] had obviously moved on, and I spent the next decade and a half on hormonal therapies. This is now 16 years later and I am here today. I am healthy and I wouldn’t be if I hadn’t had a PSA test 16 years ago.”
Medical practitioners in Barbados have been debating the pros and cons of PSA screening, and for good reason.
Prostate cancer is not only the leading one among men, but Barbados has the second highest incidence of prostate cancer in the world per capita.
Still, four family physicians –– Dr Peter Adams, Dr Colin Alert, Dr Joseph Herbert and Dr Malcolm Howitt –– have raised concerns about the PSA test, suggesting that men should be better informed about the benefits and disadvantages of screening to make an informed decision.
The Barbadian doctors argue 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
On the other side, urologists Dr Jerry Emtage and Dr Justin Emtage maintain the test is useful.
Wassersug, a professor in the Department of Urologic Sciences at the University of British Columbia, strongly believes that men should have their PSAs, which he explained is not a diagnosis of cancer but a simple, baseline blood test.
“Baseline screening is not diagnostic. It’s screening in a different way. Screening should get past the panic, people should know that by getting their baseline number they are in a position to have cancer detected early enough, and it is unlikely to be lethal, and as debilitating as it would be if they weren’t screened.
“The question is not whether you should get the PSA test or not. I encourage every man between the ages of 40 and 50 to get a baseline; it is not a diagnosis of cancer in and of itself.
“You have to look for a change in PSA to know whether or not there is prostate cancer. You have to look at continual changes, and how fast the changes are going, to know if who need biopsy, which is going to be a definitive test.”
In an interview with Health Today, while here earlier this month, to deliver a lecture on Rehabilitation And Survivorship –– What Do These Concepts Mean To Cancer Patients?, Wassersug however did not recommend mass screening or screening before the age of 40.
He noted that in North America among the white, affluent population, there was over-screening and over-treatment, while among Blacks where incidence of the disease is much higher, there was a clear need for more PSA testing.
“I would say talk to your physician as to whether you should get it very early –– 40 to 45, or wait until you are 50. The variables here would be whether there is a personal family history. If your dad had prostate cancer, your uncle had prostate cancer, then getting that screening early would matter. If there is no history of the disease and you wait until 45 or 50 that’s probably okay as well; but you’ll never know until you get the baseline screen.”
The Canadian professor insisted that the benefits of early screening were not only for prostate cancer, but could be easily applied to mammograms and breast cancer and colonoscopy for colorectal cancer –– all leading cancers.
He explained that early screening had changed the landscape of the cancer world, since doctors are only able
to detect the disease when it far too advanced.
“Screening makes cancer curable. It gives you sort of a different view than cancer is deadly. Cancer can be deadly; but now with screening, cancer is not necessarily deadly and that is a different perspective, and we need people to understand that; and the physicians should be talking it up.
“People should be going to their doctors and saying, ‘I’m 40 and 50 and 60, should I be getting screened for this or that?’.
“We are dealing with a disease we never thought would be curable. If we get cancer early, the cure is not so serious. Unfortunately, the cures are substantial if you wait until it is too late; and if we wait too long, the outcomes are fairly serious.
“Women and men need to realize, if they don’t know this: advanced cancer of the breast and prostate are not good ones to have, but if you get them treated early they are not as debilitating as they would be if they are treated late; and if they are treated too late, one can’t survive.”
The professor however noted that screening has now led to a real need for supportive care for cancer.
“We’re running into a situation where people are not necessarily cancer survivors; they are actually cancer treatment survivors, in the sense that the side effects they have are not from the cancer. What they are dealing with now is the side effects of the treatment.”
Noting that treatments were not simple or pleasant, he urged doctors to pay more attention to this area and educate their patients and families on how to better cope with
the fear and confusion surrounding cancer treatments.