Ask the Doc: Prostate cancer not death sentence

Aug. 19, 2014 @ 04:21 PM

My patient was told in 1984 that he had prostate cancer and it would likely kill him within five years. I wasn’t the one who told him. I was playing football as a senior in high school and more interested in putting people on their hind-quarters than examining them. I still had no clue I would even be a physician at that point. But our eventual crossing of paths was set.

In 1984 a diagnosis of prostate cancer usually meant only a 4 percent chance of cure. Currently, rates of 80-90 percent are common to cure prostate cancer. The difference is a screening test called the Prostatic Specific Antigen, or PSA, which was developed by T. Ming Chu, PhD, DSc and his team in the 1970s at Roswell Park Cancer Institute in Buffalo, N.Y.

It was their specific goal to isolate a blood test for screening. They did exactly that.

The PSA was released to monitor prostate cancer treatment effectiveness in 1986 and in 1994 it was approved as a screening test. There are many opinions on when, or even if, the test should be done from many different medical groups.

My patient, and I’ll call him Gary, was a stubborn sort of man and in 1984 he was 75 years old and not ready to die. He actually vowed to his doctor that he would see his 95th birthday. His doctor didn’t really see it as realistic.

When I met him in 2000 he was weaker, thin, had a lot of pain, and a lot of urinary infections from the cancer metastasis. He still had steely, blue eyes and told me he would see his 95th birthday. I admitted him to the hospital one night in 2002, just sure that his infection which was throughout his unconscious body would take him during the night. I walked in the next morning to see him sitting up, eating eggs. With a smile, he said, “Hey, Doc!”

Knowing the vastness of the tumors in his body it was unbelievable to see how he fought. His mind was sharp, even sending me an article from Scientific American on the forefront of cancer treatment one month before he died. He wanted to know if it could be developed in time for him.

He passed three months after his 95th birthday, in his hospital bed in the home he built by hand on top of his mountain looking out the window at Mt. LeConte. I am certain he lived at least 10 years on his will alone. That’s the power of the mind in the face of adversity.

Which is why I completely disagreed with the U.S. Preventive Services Task Force (USPSTF) recommendation on PSA screening that came out recently. The USPSTF states “that there is moderate to high certainty that PSA testing has no net benefit or that harms outweigh benefits.”

Briefly, their reasoning is that too many false positive tests are causing too many biopsies and that the screening really doesn’t extend life for those with diagnosed prostate cancer.

Really? I truly believe this panel of experts (which did not include any primary care physicians) has “over-thunk” the problem. The improvement in the cure rate alone should be enough of a counter-argument.

The one thing that this talented, educated, number crunching, data extracting committee cannot measure is the power of knowing and the fear and anxiety of not knowing. How does a data based decision weigh the emotions of a human mind? Medicine deals with people who have emotions, not an industrial process where a designed metal stamp produces one size fits all.

I advise my male patients by age 50 to be screened for prostate cancer including the blood test and digital rectal exam (which usually should take less than 15 seconds) if they want it. Some men decline. Some don’t. All of their wives insist on it if for no other reason but to get even for the PAP tests they have had to endure.

Family history, symptoms and race can prompt earlier screenings, but in my opinion, knowing what one is dealing with is better than not knowing anything at all. That is the power of the mind and will meeting the options and methods of treatment. Give the patient the chance to make the decision - and the consequences.

It is another example of how computers, computing, and healthcare by a committee may have a role in our data driven society, but cannot, and never should, replace the patient-physician conversation, decision and treatment.

Eric J. Littleton, M.D. is a Family Physician in Sevierville, TN. His office is located at 958 Dolly Parton Parkway. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com.