Guys Night Out: big-screen football, free sandwiches and prostate screenings

KSBW-TV in Monterey found it newsworthy to copy a local hospital’s news release and to promote its “Guys Night Out” prostate screening event on the night the San Francisco 49ers played the Washington Redskins.

The news release from the hospital’s marketing department says “The event is open to men 45-70 who have not been diagnosed with prostate cancer and have not been screened in the last two years.”

At this event, men got PSA blood tests.

The US Preventive Services Task Force recommends against PSA screening for prostate cancer, saying “there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”

Of course, the other time-honored way of screening for prostate cancer is the digital rectal exam.  That’s what NBC Today show anchors Matt Lauer and Al Roker had recently on the air (thankfully behind closed doors.)

Although it doesn’t get as much attention, there are many questions about the value of the time-honored digital rectal exams (DRE) as a screening tool for prostate cancer.  For example, read Dr. Des Spence’s piece in the BMJ, “Bad medicine: digital rectal examination.” Excerpt:

“Rectal examination of the prostate may cause more harm than good.

Rectal examination is unpleasant, invasive, and as an investigation has unknown sensitivity and specificity. In a young population digital rectal examination has almost no value, and in older patients may have very occasional and limited indication. It is time to question the once standard practice of routine digital rectal examination because it represents flimsy thinking and bad medicine.”

An analysis on UpToDate.com by Dr. Richard Hoffman, who has contributed to our content in the past on this site, noted that:

• No controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age. The majority of cancers detected by digital examination alone are clinically or pathologically advanced
• We suggest not performing digital rectal examination as part of screening.

So, to make a long story shorter, whether you’re being urged to roll up your sleeve for the PSA test or roll down your pants for the DRE – it’s a decision that deserves more thought than just being thrown in as one of the free activities at a “guys night out” for football and sandwiches.

But this is what we do to lure men in for screening – with no assurance that they comprehend the potential tradeoffs of such screening.

• We’ve seen it when Roswell Park Cancer Institute in Buffalo also used football as a lure.
• We’ve seen it when Roswell Park  lured men with hockey tickets or theater tickets and other “prizes for prostates.”
• We’ve seen it in Atlanta when a bunch of radiotherapy centers and the Morehouse School of Medicine offered Atlanta Hawks NBA basketball tickets.

There are potential harms.  They are real. They happen to real men.  They can be quantified.  Harms tend to be ignored in promotions like these.  That, in itself, is harmful – to public understanding and, inevitably, predictably, to some men.

(Hat tip to the Skeptical Scalpel for alerting me to this Monterey TV station’s “journalism.”)

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