Larry King Live presented a prostate cancer awareness program Friday night that did a terrific job of informing men about prostate cancer screening and treatment.
Unfortunately, it didn’t discuss any of the evidence that would make men think twice about prostate cancer screening or treatment. So it became another celebrity-filled promotion that was woefully lacking in evidence and, thus, was terribly one-sided and incomplete.
It featured former tennis star John McEnroe (whose father had prostate cancer), saying:
“It seems illogical not to have a PSA test. it’s hard to imagine there’s an argument against it.”
That’s a demonstration of a classic clash between intuition and evidence.
The U.S. Preventive Services Task Force states “that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.” And they recommend against screening in men age 75 years or older.
What harms could there be? The USPSTF states: “Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient’s lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life. Two recent systematic reviews of the comparative effectiveness and harms of therapies for localized prostate cancer concluded that no single therapy is superior to all others in all situations.”
But King kept hammering at the screen-screen-screen message.
King: Are we telling every man over 40 to have a PSA test?
McEnroe: I think that’s what we are telling them.
King (going to commercial break):
Take the PSA test. Men over 40, it’s a simple little blood test. You get your results back in a couple of days. Back after this…
Simple little blood test only if you don’t want the full decision-making picture – which Larry King Live failed to present.
Dr. Otis Brawley, chief medical officer of the American Cancer Society was quoted in the New York Times:
The benefits of prostate cancer screening, he said, are “modest at best and with a greater downside than any other cancer we screen for.”
And regarding the American Urological Association’s call for baseline PSA blood tests in 40-year-old men, Brawley said:
“The truth be told,I was shocked when I read that.”
But maybe John McEnroe knows more about prostate cancer than the chief medical officer of the American Cancer Society.
Several guests – Michael Milken, Colin Powell, Joe Torre – mentioned robotic prostatectomy. Powell said “increasingly it’s done by robotic surgery.” Torre said “they do it robotically now” – almost implying that was the only method.
The US Agency for Healthcare Research & Quality reminds consumers that uncertainty surrounds robotic surgery as well as many other prostate cancer treatments:
“There isn’t enough research yet to tell us how well they work compared with other treatments.”
But Larry King LIve didn’t want to use its one hour of airtime to explore uncertainty. In its incompleteness, in its sense of certainty where certainty doesn’t exist, in its imbalance, the program was a dis-service.
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Comments
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Michael Policar, MD, MPH
August 31, 2009 at 5:22 pmThanks so much for exposing the media in general, and Larry King in particular,on this subject. The reality is that that not a single major medical organization actually recommends PSA screening…following the lead of the USPSTF, most state for for men 50-70 years of age, the “advantages and disadvantages of prostate cancer screening” should be discussed and the decision left to the individual.
As a 59 year old physician and medical school associate professor, I will say that I haven’t had a PSA test and I don’t plan to have one in the future. My decision 9 years ago (when I turned 50) to forgo them is based on the evidence that you mentioned in your article…PSAs don’t catch most of the “aggressive” prostate cancers and most of the cancers that are caught would take decades to cause problems. In addition, the specificity is lousy (there are too many false positives), leading to an excess of unnecessary work-ups and invasive treatments.
Hopefully, one of these days you will do a similar article on the issue of cervical cancer screening in women. National guidelines now state that women should start Paps 3 years after first intercourse,stop at 65 (if there are 3 normals in the prior 10 years), and have them every 2-3 years in-between. No Paps are needed in the 99% of women who had their hysterectomy in the absence of cancer. Yet 55 million Paps are done in the US, annually for at least 1/2 of women, despite national guidelines that show that clinicians start doing paps too early, continue for too long, and do them too often.
Michael Policar, MD, MPH
UCSF School of Medicine
Houston Davis
September 3, 2009 at 10:43 amI can’t believe the lack of information and knowledge given by the M.D.
I am a 64 yr old male whose PSA has been monitored yearly, then it rose sharply to 7.1. Fortunately, my internist referred me to urologist who did a biopsy and then came the Gleason scores. I had a decision between surgery and radiation. A special recognition goes to the doctors at Johns Hopkins who have excellent information, knowledge, and skills to treat prostate cancer.
The point being is that PSA should be monitored and for honest and thoughtful information one should read Dr. Patrick Walsh’s Guide to Prostate Cancer.
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