RENEE MONTAGNE, host:
This is MORNING EDITION from NPR News. I'm Renee Montagne.
LINDA WERTHEIMER, host:
And I'm Linda Wertheimer. Today in Your Heath, two dilemmas of aging: treating muscles cramps and testing for prostate cancer. Millions of middle-aged men get a blood test called PSA every year. They hope it'll find prostate cancer early. But many doctors think it causes men as much harm as good. NPR's Richard Knox sorts through the controversy.
RICHARD KNOX: Like most men of a certain age, I've had a bunch of talks with my doctor about PSA - prostate-specific antigen. I get the test every year. When the results come back, my doctor and I kind of scratch our heads trying to figure our whether the number means anything or not. So far, so good.
So when I read that the guy who discovered PSA thinks that using it to screen for prostate cancer is a big mistake, I called him up, and he didn't mince words.
Dr. RICHARD ABLIN (University of Arizona): It cannot do what it's been purported to do. It can't detect prostate cancer. And it's resulted in�a public health disaster.
KNOX: He's Dr. Richard Ablin of the University of Arizona. To explain why he's so critical of PSA screening, he had to explain what prostate cancer is like. He says think of the prostate gland as a box with no top.
Dr. ABLIN: We can think of an aggressive cancer as a rabbit that jumps out of the box and spreads. The nonaggressive cancer is a turtle which crawls around the box and goes nowhere.
KNOX: The problem with the PSA test is that it can't tell if a cancer is a rabbit or a turtle, or even if there's cancer at all. It just shows whether one marker for the disease is remaining stable or going up.
That didn't stop Brad Baugher from asking his doctor for a PSA test. Baugher's on the faculty of the Oregon Episcopal School in Portland. He and his doctor go way back.
Mr. BRAD BAUGHER (Oregon Episcopal School): My personal doctor is a high school friend. We've known each for about, well, not quite 40 years.
Dr. CRAIG REDFERN: It goes back to Mrs. Ferro's(ph) class, freshman year in high school.
KNOX: Craig Redfern was a budding doctor even back then.
Dr. REDFERN: I stole her cigarettes out of her purse one day to try to get her to stop smoking, but it didn't work.
KNOX: When Brad Baugher said he wanted a PSA test, Redfern told him the test could be worse than the disease, since most prostate cancers are turtles, not rabbits.
Mr. BAUGHER: He considers it sort of a slow-growing and not-very-threatening kind of a cancer.
KNOX: Baugher got his PSA test anyway. He'd had a colleague with prostate cancer who told him to get tested. But Dr. Redfern cautioned him not to panic about whatever the result was. He didn't want his friend to start down a slippery slope toward unnecessarily treatment for a slow-growing cancer, treatment that can cause impotence and lifelong incontinence. He told Baugher about a 66-year-old patient who had a tiny spot of cancer in his prostate.
Dr. REDFERN: He probably did not need to have surgery...
KNOX: But the man insisted on it anyway.
Dr. REDFERN: ...and despite all of that, is suffering quite a bit from urinary incontinence and needs to wear a pad. So I think he's one who's done poorly.
KNOX: Brad Baugher sees it another way. He's sympathetic with that man's decision.
Mr. BAUGHER: You know, he's the one that had to go to bed every night knowing that he had cancer. And he had a hard time sleeping, I bet. Cancer's a really scary thing.
KNOX: So over the years, Dr. Redfern gave Baugher a couple of PSAs. The results remained stable. Then when Baugher was 55, he had some urinary symptoms. His wife said, get it checked out. Another PSA test had a higher score. Then two months later, it jumped up again.
Dr. REDFERN: Since he was my friend and I didn't want any potential conflict of interest in decision-making, I suggested he just see the urologist and decide whether to proceed with the biopsy.
KNOX: They went ahead. The biopsy found not just cancer, but pervasive cancer. Fortunately, though, Baugher's cancer seemed limited to the prostate. He had it removed, and he's doing well 18 months after the surgery. And now he's glad he had that series of PSA tests.
Mr. BAUGHER: Yeah, I think maybe the tests did save my life.
KNOX: I asked Dr. Redfern what he thinks might've happened with the cancer if his friend hadn't had all those PSA tests.
Dr. REDFERN: Probably in two or three years, it may have become apparent in other ways, and at that point not likely to be curable.
KNOX: Brad Baugher represents the proper use of PSA testing. Don't do anything on a single test, but monitor the results over a period of time. The problem is not all doctors are doing it that way. There are still a whole lot of biopsies, surgeries and radiation treatments being done on the basis of a single above-normal PSA test at great cost to patients and the health care system. But Baugher says the health care system is a system.
Mr. BAUGHER: I'm not part of the health care system. I'm just me, trying to stay healthy.
KNOX: As for Redfern, he points to a European study last year that says for every Brad Baugher whose life is saved, you end doing treatments on 48 others who probably didn't need it. Many of those are left incontinent and impotent as a result. Even so, the study has Redfern leaning a little more toward recommending PSA tests to his patients.
Dr. REDFERN: But I usually also follow that up by noting that I've opted not to have my PSA tested.
KNOX: Every man, he says, has to decide for himself.
Richard Knox, NPR News.
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