Testing saves less than one life in a thousand and has its own perils. The great majority of men who get chopped about as a result would have been OK if left aloneProstate proposal risky
In 2003, Professor Alan Coates, then 58 and head of Cancer Council Australia, admitted he had not had, and wasn't planning to have, a test to see if he had prostate cancer. Wayne Swan, a prostate cancer survivor, called his statement "public policy vandalism".
Coates was not a lone heretic. While it would be rare to find a smoker working in cancer control, or any woman in the same field who had not had a Pap smear, many men who know much about the evidence on whether prostate testing saves lives have not been tested themselves.
A study in 2002 of male GPs in Victoria aged over 48 found less than half had been tested; many physicians choose to remain ignorant about whether they have the disease. What do they know that the Urological Society of Australia and New Zealand does not?
The society has recommended 40 as the age for men to consider having their first prostate-specific antigen test, or PSA, and for those in the top half of PSA levels to be considered higher risk and "monitored closely". Those with lower levels could have less frequent testing.
Earlier this year, results from a European trial involving 160,000 men aged 55-69 were published in the New England Journal of Medicine. Only some were given PSA tests. It showed that if you screen 1000 men, you will find 82 cases, and if you follow these men for an average of nine years, there will be 2.94 deaths. In 1000 unscreened men over the same period, 48 cases of prostate cancer will come to light by men presenting symptoms to their doctor. There will be 3.65 deaths. The difference between the two means, in short, testing saves 0.71 deaths per 1000 men over nine years.
Prostate cancer is a disease from which you are more likely to die very late in life. For elderly men - those over 84 - the death rate is 767 per 100,000 men, while for those aged 40 to 44 it is 0.3. This means there will be one death per year from prostate cancer in every 330,000 men aged 40-44, an age group the Urological Society now believes should be testedhttp://www.smh.com.au/opinion/prostate-pro...90923-g2l1.html