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That kind of restraint will not be easy. Over the past several decades, much of American medical practice and public expectation has been geared toward the idea that if someone has cancer, it should be treated without delay, observes Dr. Gerald Chodak, a urologist at the University of Chicago. But as blood tests and biopsies detect ever smaller cancers, physicians and patients will have to make more sophisticated decisions about treatment.
It does not make sense for everyone to be tested -- particularly patients who are within 10 years of the end of their expected life-spans. "The perfect example is an 86-year-old guy I just saw in my office," says Chodak. Another doctor had found an elevated PSA level in the patient. "He went for a biopsy, and he's got prostate cancer. Now, this guy is not going to benefit at all from his diagnosis. The last thing I would do for an 86-year-old guy is test him."
But for every anecdote about overtreatment, there is one about saving a life. "Five years ago, I would not tell a man who came into my office to have a PSA test," says Dr. Perinchery Narayan, chief of urology at the Veterans Affairs Medical Center in San Francisco. "I would say, 'Let's do a digital rectal exam, and if everything's fine, we'll do another next year.' Today when any man 50 or older comes into my office, I'll sit down with him and tell him about prostate cancer and advise that he get a PSA test." For too long, there were no options left by the time prostate cancer was diagnosed. Used wisely, the PSA test is an opportunity to improve the odds of survival.
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