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Wednesday, October 5, 2016

My brother, Ben Stiller

Ben Stiller has disclosed that he is recovering for treatment of prostate cancer, which afflicted him at age 46. Without PSA screening that detected the cancer before it became symptomatic and (more importantly) before it metastasized, he believes he would have died.

I'm with you, Ben. That's my story, too. I was 51 when my PSA test showed a problem. Like him, my "Gleason score" was 7. Like him, I underwent laparascopic surgery assisted by a robot. Like him, I am alive today with a zero PSA level — which, after one's prostate has been removed, is an unambiguous statement that no prostate cancer remains.

Unfortunately, the U.S. Preventive Services Task Force continues to tell men that they should not have PSA testing in the absence of symptoms. It's absurd. Their position effectively condemns men like Ben and myself to an early, unnecessary death.

The argument from USPTF is that a PSA test is not specific to prostate cancer. Non-cancerous diseases of the prostate can elevate one's PSA. That's true. In order to diagnose prostate cancer, one's prostate must be biopsied. This is a painful procedure that has its own risks and has a high price tag. That's true. There is a chance that the biopsy will give a false negative (in other words, that it will not find cancer even though the cancer is present). That's true. There is a possibility that some men will panic and rush to treatment by surgery or radiation, even though their particular type of prostate cancer is so slow-growing that it would not pose a threat for 10 or 20 years. That's true. There is also a possibility that some doctors practicing defensive medicine or hungry for income will encourage patients to get treated when waiting would be a better decision. That's true.

But in cases like Ben's and mine, the situation simply doesn't play out that way. Ben and I had 35-40 years of projected lifespan ahead of us; we were not octagenarians likely to die of something else soon. Our cancers were asymptomatic; I had "digital exams" (guys, you know what that is) by at least ten physicians before surgery. None of them could feel anything amiss, and of course I hadn't noticed any symptom myself. Our cancers were fast-growing, not slow-growing. His PSA level was rising rapidly, and so was mine. In fact, in the months it took between my initial test and my surgery, I passed from the zone of intermediate risk (PSA=15) to the zone of high risk (PSA=25). Usually a PSA of 6 is considered ominous, if it continues to rise. After my surgery it came to light that my cancer had just begun to spread outside the prostate.

There is zero doubt that without PSA screening, my cancer would have become untreatable within a year and that I would not be alive today. No doctor familiar with my history believes otherwise. And when I wrote an MD at the USPTF to object, he didn't dispute my imminent and certain demise. He simply replied that in the aggregate, too much money is being spent on unnecessary treatments and the complications they cause. In other words, it's ok for men like Ben and myself to die prematurely just because other men and their doctors are making poor decisions.

I think that sucks.

Do we need a more specific test than PSA? Yes. Do we need more conservative treatment — in some cases, engaging in "watchful waiting"? Yes. Are those sufficient reasons to tell men not to get screened in the first place? No.

Someday the brotherhood that Ben and I belong to will be joined by one of physicians who participates in the USPTF. At that point, I expect to see change in the recommendation. Until then, ignore the USPTF and get screened. It could mean your life, too.