Testy over the PSA test

Ben Stiller as Derek Zoolander, doing a "More You Know" spoof.

Ben Stiller as Derek Zoolander, doing a “More You Know” spoof.

We’ve been doing a lot of great coverage at HealthNewsReview.org over the lesser-known, lesser-reported downsides of the PSA test–which is one of the ways doctors can screen for prostate cancer in men.

It’s a far-from-perfect test that generates a less-than-idea false-positive rate, leading to invasive, harmful procedures that can leave men incontinent and impotent. Not good. As a result, many medical groups strongly discourage public screening events where the PSA test is often pushed onto men as a way to “take charge of their health.”

Yet despite this shift in knowledge–that the science strongly shows the PSA test shouldn’t be doled out indiscriminately to men over a certain age–we’re still at a point where the public at large, including oncologists, don’t really agree. To write critically about the PSA test is to invite criticism for being hostile to men with cancer and the doctors who treat them. And many will let you know this.

As a result, over the past few weeks, we’ve been interviewed by newspapers, and engaged in Twitter chats with celebrities like Ben Stiller. It’s been fascinating to see the debate back-and-forth.

Here’s a look:

Despite thumbs down from professional groups, mass prostate cancer screening events continue, often with misleading promotions

This criticism of a mass screening event in Buffalo, NY, was noticed by the local newspaper reporter who covers health. He interviewed me in The Buffalo News:

Roswell Park promotion for prostate cancer screening fires up debate over test

That same week, I also did a round-up of the news coverage on a big, well-done New England Journal of Medicine study that revealed “active monitoring” for prostate cancer leads to the same outcomes as radiation or surgery–meaning men can feel more confident in their choice to not have invasive treatment:

Overall impressive: News media coverage of NEJM study on treating vs not treating prostate cancer

As well, our managing editor, Kevin Lomangino, looked at some of the flaws in the logic behind a recent essay by Ben Stiller, who espouses that his PSA test “saved his life.”

Ben Stiller’s misguided prostate cancer recommendations aren’t based on evidence

Stiller said a lot of things right in his essay–he noted that the test isn’t without its drawbacks, and that men should talk to their doctor before jumping right into testing. However, a PSA test is not life-saving: The cancer could still recur in Ben, for example. It’s a tool–not a lcure.

We took a lot of heat for saying that, but we were also supported by people like Dr. Otis Brawley, chief medical officer for the American Cancer Society, who wrote a rebuttal to Stiller’s piece:

Prostate Cancer Screening: The Scientific View

There are countless instances where men with no symptoms, no known family history, no other risk factors, undergo screening for prostate cancer, who have prostate cancer detected, treated, and are left better off. And it would be hard to convince these men that screening did not save their lives.

But we now know that the majority of men with prostate cancer will not die of their disease, whether they receive aggressive treatment, are watched carefully, or even if it was never diagnosed.

The harsh truth is that even under the best conditions, with careful screening, some men will still die of prostate cancer.

One of the wisest comments–one that I see play out over and over again as a science communicator–came from a commenter on Kevin’s blog post:

Reading the comment section here, I am reminded of the greatest challenge we face when communicating the results of large studies that influence screening policies: personal experience always trumps data in the human brain. We can show the most rigorous data pile to someone but, if its conclusion is counter-intuitive, that person will still say, “But it worked for me.” Therein lies the real challenge of increasing scientific literacy: getting people to let go of personal experience.

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