June 5, 2012

The “annual physical for healthy, asymptomatic adults is an inefficient gauge of health [and] more likely to find false positives than real disease.” (“Let’s (Not) Get Physicals,” by Elisabeth Rosenthal, Week in Review, New York Times, Sunday, June 3, page 1).

The article reports that the United States Preventive Services Task Force no longer recommends prostate specific antigen blood tests, routine EKGs, and frequent Pap smears. An earlier report said that regular mammograms are also unnecessary.

This Task Force says that harm is caused by many unnecessary medical procedures and that these tests and procedures drive up the cost of health care in America that spends twice the amount per person in comparison with other developed countries without making people better. Indeed, it says that based on the science and statistical analysis, side effects from many tests and procedures end up causing greater harm to the patient than the good they address.

Had I personally followed this Task Force recommendation and an earlier one released in May on the PSA test, I’d be dead today, or near death.

My story in brief: Three plus years ago my wife Barbara said to me, “John – you need to call the doctor as you’ve not had a physical for more than a year.” I was 59 years old then, in pretty good shape and almost never got sick.

“I’m fine,” I said.

She insisted, “Get a physical – and while you’re at it, get your PSA checked!”

I relented, called my doctor and scheduled an appointment. The year before my PSA was normal, and so I wasn’t worried. This time, however, there was a dramatic change. My numbers had more than doubled. While digitally examining me, my doctor felt a mass. He ordered a more specific test to determine whether my raised PSA number was a false positive. It came back positive again. He recommended a biopsy, and the results confirmed that a cancerous tumor was growing in my prostate measuring 9 on the Gleason scale. 10 is almost always fatal; 9 is often fatal. I was in trouble.

What had happened? Wasn’t prostate cancer slow-growing? Why suddenly did I have elevated levels and a large tumor?

My brother, an oncologist, surmised that my tumor was probably growing slowly over several years and remained undetectable, but suddenly it became aggressive, grew quickly and had reached a dangerous state.

In the United States nearly 200,000 men are diagnosed with prostate cancer annually. Of those 25,000 die from the disease.

Was I one of the 25,000? I feared the worst until after the surgery and my surgeon gave me the good news that he successfully removed the tumor in time. Had I waited another three or four months for a check-up, it might have been too late as the rate of the tumor’s growth meant the likelihood of it having spread beyond the prostate.

My surgeon said that my margins seemed clear, but to be certain my radiology oncologist recommended eight weeks of radiation as a prophylactic to kill microscopic cancer cells that might still be lurking. The total hospital bill topped $150,000, most of it paid by insurance.

I can say without a doubt that I am alive today and “cancer free” because my wife was vigilant and urged me to go for an annual physical examination, and that I had asked for a prostate specific antigen blood test even though I was asymptomatic. The physical and this blood test are the very two items this US Preventive Services Task Force said were unnecessary.

I do not, consequently, take seriously the Task Force’s recommendations. Most responsible doctors I know also reject the view that annual physicals are unwarranted, that PSA tests are useless, that Pap smears, mammograms, and other regular tests are unnecessary.

Dr. Mark Litwin, chair of urology at UCLA, following yet another U.S. Preventive Services Task Force report on the usefulness of the PSA test (LA Times May 23, 2012) said that the real problem is not the test but the rush to treatment. He does not believe that the PSA test should be dumped. “Therein lies the crux of the problem,” he said. “The issue is not so much should an individual be screened—it hinges more on should an individual be treated.”

So – here is my point in writing: If you have not had a colonoscopy lately, have avoided PSA tests, digital exams, mammograms, EKGs, stress tests, or any other ongoing ache, pain or seemingly innocuous symptom, pick up the phone, call for an appointment with your physician, and get yourself checked out.

It could save your life. It did mine!