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Prostate Testing Conundrum

September 4, 2015

The article ‘Watchful Waiting’ Becoming More Common For Prostate Cancer Patients, presents a perplexing choice for African-American men considering PSA testing.

Dr. Matthew Cooperberg, the Helen Diller Family Chair in Urology at the University of California, San Francisco states in the article, “Ultimately, the number of men who will die of prostate cancer because they chose active surveillance cannot be zero by definition,” and he acknowledged, “But it is a very low number, far lower by most estimations than the number of those harmed by avoidable surgery, radiation, etc.”

The conundrum of  not zero versus very low should especially concern  African-American men since we die at the highest rate from prostate cancer and are statistically under-represented in prostate cancer studies referenced by Dr. Cooperberg.

The article concludes with a statement by Dr. David Penson, the Hamilton and Howd Chair in Urologic Oncology at Vanderbilt University Medical Center, “One of the arguments against screening is that we are over-detecting and over-treating prostate cancer, and because we are over-treating men who don’t need treatment, we are doing more harm than good. By reducing the rates of overtreatment, we are likely increasing the benefit of screening.”

As an African-American seven year prostate cancer survivor, I’m concerned doctors will use the above arguments and recommend fewer PSA screenings─ thereby reducing African-American men access to data they’ll need to make critical decisions.

Seven years ago my PSA was less than 4; however, its rate of change had increased over the prior three years. I could have waited, but I selected to get a biopsy. My Gleason score was a 3+3, considered by some low risk. But by then at 59-years-old, I had survived tongue cancer thirteen years and neck cancer eleven years. I elected robotic surgery.

What would have been your choice?

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