Friday, November 9

Me and my prostate: An executive summary

Sometimes you can get too close to a topic. And that's what happened in my earlier post, the one which follows this.

I've been tossing around since the early hours wondering what to do about it. Surely it's too long? Does it say far more about my prostate than you really want to know? Is it boring?

And worse, does it fail to drive home arguments I believe to be important?

Yes, yes, yes and yes! Then, about 4am, the answer came to me. What I need is an executive summary.

So here's a first from Grumpy Old Journo. An executive summary:

  • Professor Simon Chapman, and many other researchers, believe prostate cancer screening isn't worthwhile.
  • The initial screening is unreliable. If abnormalities are found, the patient must have a biopsy to confirm diagnosis, and the biopsy procedure itself carries risks.
  • Even if a man has prostate cancer, he's probably going to die of something else first. Many men have prostate cancer when they die, but they've never had symptoms and it's not what killed them.
  • Treatment may end the patient's sex life and leave him wearing incontinence pads. Even if it does extend his life – and that's uncertain – his quality of life may be diminished.
  • However, screening may become valuable if better screening tests can be developed.

    Against that, I'd like to put a counter-argument based on my experience and my reading:

    • Despite their shortcomings, screening tests can indicate prostate cancer.
    • Follow-up biopsies do carry risks of infection and some pain, but they are valuable, not only in confirming a cancer diagnosis, but in calculating the aggressiveness of the cancer – is it likely to spread into lymph nodes and pelvic bones?
    • With this information, a guy (and his wife) can make sensible decisions about treatment options, including the option of no treatment. All specialists will explain the pros and cons
      of treatment they suggest and will offer booklets which set out that advice.
    • Professor Chapman's findings are based on statistical analysis of thousands of men. With sound evidence, good advice and sensible decisions, a guy could beat the odds.
    • Screening is the first step on the path which may lead you to a better outcome.
    Jesus wasn't talking about the prostate health of his listeners, of course, but you might find his words of value when you think about screening:

      "You shall know the truth, and the truth will set you free" [John 8:32]

      I've got the following links at the end of the next post, but to save your time, here they are again: Professor Chapman's article in the Sydney Morning Herald, and a long, detailed Wikipedia entry.

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