IN A front-page story, The May22 Globe reports the recommendation that “healthy men” should not undergo prostate cancer screening. If one is “healthy,” why go to the doctor at all? Here is a classic Catch-22: If you are healthy, you don’t need to see a doctor, but the only way to know that you are healthy is to see a doctor.
The reason we see a doctor when we feel well is to confirm that we are so blessed, and to identify treatable risk factors that might get us into trouble later. the level of PSA is a risk factor for prostate cancer, as are ethnicity, family history, and age. Perhaps age is the greatest risk factor, but we don’t test the PSA of the elderly because it is likely that they will die before prostate cancer becomes sufficiently advanced to kill them.
This is not true of men in their 40s and 50s. For those age groups, I think it is prudent to do an initial PSA. If the result is low (below 1), the data reliably predict low risk, and further screening for prostate cancer can reasonably be omitted. If greater than 1, it is appropriate to test again. If PSA rises faster than predicted by age, then surveillance is prudent, in order to take action should a tumor be detected and there is evidence of its potential to spread.
I think the guideline should advise men from age 40 to 60 to have an initial PSA test.
The writer is an instructor in medicine at Harvard Medical School.