Prostate cancer (discussed here) continues to be an in-vogue topic, as evidenced by Dr Newt Gingrich’s astute observations. The prostate, it seems, weighs heavily on the death panels as they deliberate.

As I wrote in another venue:

The USPSTF recommends against prostate-specific antigen (PSA)-based screening for prostate cancer. It does so although prostate cancer is a common cancer that 2.8 percent of men will eventually die from. The reason that screening is not recommended is that the vast majority of men who have an unsuspected cancer detected by screening have a tumor that is so slow-growing that it will not affect the man’s lifespan or result in poor health – most likely he will die of another cause first.

In addition, false-positive tests – tests where the PSA is elevated but no cancer is found – are associated with a persistent worry about prostate cancer and other unfounded health fears. The USPSTF reports that men having a false-positive test are more likely to have additional testing, including biopsies, in the following year than those who have a negative test. Over a 10-year period, as many as 20 percent of men will have an abnormal result that triggers a biopsy, with very few of these men ever being diagnosed with cancer.

The USPSTF found that a number of men biopsied will suffer from fever, infection, bleeding, transient problems urinating, as well as pain. Of the men who are found to have cancer, almost all will have aggressive therapy. The evidence is that these men will not have a longer life as a consequence of their cancer treatment. The treatment is not benign. Almost 1 percent of men will die within 30 days of undergoing radical prostatectomy, and another one in 20 will have serious surgical complications. Those that survive the surgery will have more sexual problems and urination problems than those who elect to not have aggressive therapy even if they have cancer.

Or, put another way:

Imagine you are one of 100 men in a room,” he says. “Seventeen of you will be diagnosed with prostate cancer, and three are destined to die from it. But nobody knows which ones.” Now imagine there is a man wearing a white coat on the other side of the door. In his hand are 17 pills, one of which will save the life of one of the men with prostate cancer. “You’d probably want to invite him into the room to deliver the pill, wouldn’t you?” Newman says.

Statistics for the effects of P.S.A. testing are often represented this way — only in terms of possible benefit. But Newman says that to completely convey the P.S.A. screening story, you have to extend the metaphor. After handing out the pills, the man in the white coat randomly shoots one of the 17 men dead. Then he shoots 10 more in the groin, leaving them impotent or incontinent.

Heck of a death panel, isn’t it?

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