Dr Tom: It's my prostate and I want it checked, thank you
One of the problems with medicine is that if you ask five doctors a question, you may get five different opinions.
The evidence for screening and prevention of diseases is confusing on a number of levels for doctors and patients alike. My last week's column on men's health and prostate checks is no exception. The website prostate.org.nz recommends prostate screening and tests for men over the age of 45 while the site prostate.org.au does not recommend prostate screening and tests for men with no symptoms or low risk (no family history) of prostate cancer.
One reader emailed me to ask why I would recommend getting your prostate checked. Another reader wanted to know why GPs do not recommend prostate cancer checks. Twice, this patient asked for a prostate blood test for the Prostate Specific Antigen by his doctors and twice he was refused on the grounds it was low risk and not necessary. So, one can understand his shock at being diagnosed with prostate cancer.
It seems the argument lies in the fact that if a man is tested at age 65 for prostate cancer he may die of it at age 75, despite treatment and side effects. Another man who has no symptoms but has prostate cancer at age 65 may develop symptoms at age 70 but still dies at age 75 and has had no surgery or chemotherapy.
The problem with this argument as I see it, is that to deny a person a blood test or rectal examination for prostate cancer denies the patient the right to know if they have cancer or not. Many men prefer not to know and die of prostate cancer. Other men want to know and actively pursue treatment, which may or may not save or extend their life.
I personally know young men who have been diagnosed with prostate cancer and if they had not been tested and treated, they most certainly would have died. The difference lies in the benefit of mass screening and the population versus the benefit to the individual.
Telling a man who wants a prostate check that they don't need it is both patronising and dangerous.
As in the case of one reader, diagnosed with prostate cancer and understandably angry, he doesn't know if treatment would have made a difference because he never had the chance to decide. How can it be informed consent if you are not informed of your blood results because you were advised not to have them?
The fact that there is debate and confusion is because individuals do not behave like a general population. Cancer follows its own path and this screening debate in those who have no symptoms is not confined to prostate cancer alone.
My opinion is that I want to know my numbers and my PSA level, and find out if I have cancer or not. If I do then I will talk to a urologist to decide the risks vs benefits of treatment.
If it appears normal I will feel reassured until my next annual check-up or until I get symptoms of prostate problems, such as reduced urine flow, dribbling, blood in my urine etc.
That's why I am off to my own doctor this week for my annual check-up. She recommends annual check-ups and if she didn't, I would seek a second opinion as it's my prostate, not hers.
Dr Tom Mulholland is an Emergency Department doctor and GP with more than 25 years' experience in New Zealand. He's currently on a mission, tackling health missions around the world.