By Daniel Stone
The metastatic cancer diagnosis of Joe Biden brings together two controversial issues: PSA tests for prostate cancer and presidential politics. To understand what is at stake, Americans need basic information about PSA tests and a candid discussion about the reasoning behind the decisions about the screening of prostate cancer in the case of the former president. The dribble of information we have received only creates more uncomfortable questions for Biden and his family. The absence of adequate statement also does not contribute to the public appreciation for these important medical issues.
The prostate, a walnut -shaped gland at the base of the bladder, produces “prostate -specific antigen” or PSA. Chemically classified as a glycoprotein, a sugar/protein aggregate, it leaks from the prostate in the blood, where the level can be measured with routine blood tests.
As men get older, gets bigger, the PSA levels increase. Screening tests make use of the fact that prostate cancer usually leaks more PSA than normal prostate tissue. And in the case of prostate cancer, the PSA usually rises relatively quickly.
In addition to these basic facts, the PSA story will be blurred. Although an elevated PSA can indicate cancer, most men with an elevated PSA have a benign prostate enlargement, no prostate cancer. Even worse, for screening, many men with prostate cancer have a mild and slow -moving disease that does not require treatment. Together with their illness, they exist instead of dying. This fact leads to the old saying that prostate cancer is the disease of long -lasting popes and judges of the Supreme Court.
Medical advice panels view PSA screening with skepticism partly because of the challenges of distinguishing benign PSA increases from those related to cancer. The confirming of a suspected diagnosis of cancer requires prostate biopsy that can be painful and cause side effects. In addition, as soon as a diagnosis has been made, patients who may have possible together with their illness can be unnecessarily subject to the damage to treatment, such as radiation and surgery. Finally, the benefits of early treatment of prostate cancer are difficult to prove in clinical studies.
For all these reasons, medical advisory panels have discouraged widespread tests or recommended a nuanced approach with a careful discussion of risks and benefits between patients and theirs
Despite these worries, the pendulum has been waved to more PSA tests in recent years. One reason is that improvements in radiographic imaging, such as MRI, allow ‘active surveillance’ that can follow early lesions for signs of spread, allowing doctors to distinguish between relatively benign cases of prostate cancer and that will probably claim. Interventions can then be more specifically aimed at that with a high risk.
In my medical practice I have generally been an advocate for screening for prostate cancer, despite the controversy around the clinical benefits. My experience makes me believe that early diagnosis improves prognosis. But even without improved medical results, patients and their families still benefit from early diagnosis for planning. Nobody wants to be Sideswiped by a symptomatic disease in a late stage that limits both clinical and life choices.
In the case of Biden, a spokesperson revealed after some initial delay on 20 May that since 2014 there was no PSA tests during the Vice Presidential of Biden. The reasons were not revealed.
Such a decision can be justified on the basis of questions about the benefits and risks of PSA tests. In view of the importance of the health of a vice -president and potential future president, however, would have expected doctors to be mistaken on the part of more information. The omission invites speculation that the political implications of a borderline or increasing PSA may have played a decisive role. More information about his latest PSA and the basis for the decision not to continue with screening can rest such speculation.
In the past, the public has gained insight into important medical disorders of the unfortunate ailments that influence the first families. Screening of colon cancer received an increased attention afterwards President Reagan’s diagnosis in 1985. Betty Ford’s public disclosure of its struggles With alcoholism and prescribed drug dependence, de-stigmatization helped the treatment for substance use disorders.
Biden’s disease also offers an opportunity. Remember that prostate cancer entails the greatest risk of death in cancer with which non-smoking American men are confronted. Transparency in dealing with the condition of the former president would be the public interest by increasing the consciousness and understanding of the important, nuanced care decisions with which so many men are confronted.
Daniel Stone is a practicing internist and geriatric at Cedars Sinai Medical Group. This piece was originally Published in De La Times
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