Tuesday, September 28, 2010

The story of a man

This is the story of a man I know. This man is over 50, and has been receiving PSA (prostate specific androgen) tests for the past few years, as do many men over 50. PSA tests are controversial because an increase in PSA doesn't necessarily mean that something is wrong. It's a screening test. And as we know, screening tests are often problematic (see: mammograms).

So about a month ago, this man came home from the doctor and said: my PSA is higher than it was last time, the doctor wants me to go to a urologist for follow up.


So this man goes to the urologist for follow up, and the urologist does a DRE (digital rectal exam) and says, hmm, your prostate is possibly enlarged, but I don't really feel anything abnormal, but I think we should do an ultrasound of your prostate and possibly a biopsy.

The man schedules the ultrasound and biopsy for 2 months in the future.

The man thinks about this, and it starts to drive him crazy. So he decides to reschedule the procedure to one month in the future.

And then he tries to forget about it.

Life goes on, the summer ends, school begins, the holidays come, and now it's time for the procedure.

The man has to do some unpleasant things in preparation for the procedure, but he does them, and goes in for the ultrasound and biopsy. The urologist does the ultrasound, says he doesn't really see anything untoward, but does the prostate biopsy anyway. Twelve tiny samples.

The urologist says the results will be back in a week.

The man waits.

Now, there is a large gap between "you have an elevated PSA level" and "you have cancer," but to the man and his family, this gap was getting smaller by the day.

There were really only 2 possible options: "you have prostate cancer," or "you don't have prostate cancer."

The man's wife works in the health field and keeps looking at articles online. This just isn't right, she complains. It says that if you have a PSA increase, that it could be due to something else. It could be a false positive. It says to follow up with DRE. If that is troublesome, you then go to ultrasound. If that is troublesome, you then go to biopsy. Why did they go straight to biopsy?

The man didn't know, and told his wife that he didn't really want to talk about it until he got the results of the biopsy.

So they waited.

And waited.

They kept thinking about the worst, and the best, and everything in between.

And they waited.

And suddenly, out of the blue, the urologist called the man one afternoon and said: there is no cancer. And the man called his wife, and said: there is no cancer. And they were very very happy.

But the man's wife was still angry. Happy, but angry.

And this is not the end of the story.

P.S. I keep finding more and more articles about cancer screening and how tricky it is. Take a look here and here.


Kibbitz said...

I am unsure how I would react. As an uniformed patient, how can I question the doctors advice? If this happens to me, do I say, wait until you test my PSA again and if it elevates we can try the next thing. What risks do I take? Wouldn't that also drive me crazy?

While this man did not have prostate cancer, other friends have.

I understand your anger because this puts entire families into unneeded stress. But what are the valid alternatives.

adena said...

Yes, it is a dilemma. What I don't understand is why this dr. went to biopsy if he saw no other signs of cancer. The problem with this test is that even if it finds cancer, there is no way of knowing - yet - whether it is a slow growing cancer or a fast growing cancer. So everyone tends to be treated as if it's fast growing. And that leads to over-treatment. But you're right...it's hard to know what to do.