PSA stands for protein-specific antigens, which are produced by the prostate gland in the human body. When the protein level in the blood, as a result of the secretion, crosses 4 ng/mL, it is indicative of prostate cancer. However, in the last 17 years since the test was approved, only 3.8 per cent of the men tested turned out to have prostate cancer even though thousands underwent painful surgeries as a result of false positives. This has resulted in widespread debates on the subject emerging in the USA as well as in other countries that use the PSA test regarding its risks and cost benefits.
The issue was covered comprehensively by the mass media and especially by three publications in the United States: The New York Times, LA Times and the Washington Post. NYT also carried an essay by Ablin last year (dated 9 March, 2010). However, while the focus in all three publications was on the emerging dissatisfaction amongst test subjects, urologists and policy-makers, each of the newspapers focused on one distinct and important aspect of the story.
[caption id="attachment_20488" align="aligncenter" width="397" caption="Richard J. Ablin"]
[/caption]The NY Times article evaluated the test and presented a series of numbers that highlighted its failure to be comprehensive, robust and reliable. Quoting the results of a study undertaken by the US Preventive Services Task Force (USPSTF), the article stresses on the test's inability to influence healthcare positively and the onus it places on the Ministry of Health to substitute it with one that works. Furthermore, the article also argues against the test's obsession with simply the symptoms of the cancer and its inability to discern the precise causes of those symptoms as being a significant contributor to its failure.
In doing so, it sidesteps the cost-versus risk conflict that has arisen as a result and instead, by condemning the technique, does not offer any judgment on the need to administer the test by the FDA. At the same time, the article fails to mention the absence of any urologists on the panel and, therefore, loses the balance it could have otherwise retained. Whether this was done deliberately to restrict the readers' attention to the shortcomings of the test or not is unknown.
The Los Angeles Times article went another way and evaluated the consequences of the administration of the test. While the debate on its administration perseveres, that the consequences are responsible for its happening in the first place were here brought to light. With a number like 3.8 per cent, the first thing that comes to mind is not the apparent commonality of the disease but the incredible failure rate - which is compounded by the painful implications of a prostatectomy.
When the prostate gland is removed, a man's capability to produce semen, or for that matter to get or sustain an erection, is severely reduced. Given the thousands of men tested since 1994, it arises that for every 48 people tested, 1 is diagnosed successfully with prostate cancer while 47 have unnecessary trouble staying out of the bathroom for long. In fact, a randomized study, where test subjects were divided between one group that received yearly PSA tests and another that received "usual care", reported in the same article highlights the disparity: 50 from the special group died over the course of 10 years as opposed to 44 from the "usual care" group.
In hindsight, this forces men to make tough choices post-testing, choices that can make or break a family in many cases. That this test is forcing such choices to be made is the point of condemnation and not the ineffectiveness of the test itself, argues the LA Times. If anything, the socio-economic outcome seems unconstitutional. As the writer puts it, it is "his prerogative, his prostate."
As the NYT article fails to point out, as Ablin argues in his essay for the NYT, as the LA Times post suggests, a small shift in the target demographic could yield far better results. Men in the age-group of 50 to 75 are "much more likely to die with prostate cancer and much less likely to die of prostate cancer". This is because the disease develops very slowly. Therefore, instead of getting every man older than 25 tested, it would make much more sense to not destroy the lives of most young men in all probability.
The third publication, the Washington Post, evaluated the options presented by the test. This is not to say that it didn't consider the test itself or its dire consequences. On the contrary, it has presented them in a way as to be balanced so its readers could judge their relevance based on the options that the test presented to those who underwent it.
In the last 17 years, the administration of the test has cost $3 billion, not to mention the costs of those who underwent surgeries and subsequent treatment. For someone who has read only the NYT and LAT articles, the presence of such a number instantly forces the conclusion that the test has to go. However, what about those whose lives were saved simply because of the test? How do you argue with them? This is the most important line of thought taken up by the WP, a line that has been missing from the other two newspapers. The lack of suggestions is made up for by increasing the awareness of the people so that public debate becomes more informed - instead of relying solely on the judgments of doctors.
After all, heaping condemnation on the most accessible test to detect for the most prevalent disease in the USA cannot go unopposed.
This comparison reminds me of something else I've been thinking about: if you were writing this article, would you go ahead and be responsibly suggestive like NYT and LAT were or would you hold back, stay fully neutral and continue to just provide information like the WP did?
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