Time Immortal

Tony Waters offers his thoughts on the issue of prostate cancer detection in response to my article on the subject:

I agree that the PSA test is not necessarily a positive test of cancer and can be attributed to other causes. This in fact was the case of a friend of mine who tested postive, he did not have cancer at the time. But, two years later there were more problems and my friend still does not know the outcome. The other point I would like to make is that I have a friend who’s husband did in fact die of prostate cancer three years ago, he was in his late fifties. Hopefully these items will put a different perspective on the idea that men do not die of prostate cancer.

My heart goes out to the wife of Mr. Waters’ friend; that must have been a tragic loss.

As I noted in my article, I fail to see how any early detection of cancer could fail to increase survivability. Okay, we can take it as granted that prostate cancer is easier to detect, and easier to treat, than some other forms of cancer, and we can even take it as read that prostate cancer is typically less virulent than other forms of cancer.

It’s still cancer. It’s still better to detect and treat it early. Yes, not many people may die from prostate cancer, but — as Mr. Waters points out — people can and do sometimes die from it.

And any test which could potentially disclose a problem — including cancer — with the prostate should be eligible for public funding, especially if it is a test that a doctor has prescribed.

B.C. men will have to continue to pay for prostate cancer screening.

The B.C. Human Rights Tribunal has rejected a claim by Laurence Armstrong, a Victoria lawyer, that men face discrimination in having to pay for tests, while women get mammograms and Pap smears for free. The decision was published Thursday.

Armstrong told CBC News that he was annoyed at having to pay $30 for every PSA test recommended by his doctor.

“I’d be sitting in the lab waiting room watching the women go in for mammographies, not paying,” said Armstrong, who decided to take the matter to the human rights tribunal, which heard the case in 2006.

And the reason they dismissed the claim? The uncertain efficiency of the PSA test.

Armstrong, 59 at the time of the hearing, said his doctors have recommended PSA screening for him since he was in his mid-40s. He’s had no symptoms of prostate cancer.

Susan O’Reilly, vice-president of the , said the ruling makes sense.

“The women being screened either for breast cancer with mammograms or cervical cancer with Pap tests, there’s compelling information to tell us if you diagnose these cancers early you will cure more people and their life expectancy will, as a result, be much better,” she said.

“In the situation with this blood test for prostate cancer, we still don’t have that evidence,” she said.

The test measures a substance produced by the prostate, called prostate specific antigen. It’s especially useful for monitoring established prostate cancer and as a diagnostic aid, in combination with other tests, for early detection of prostate cancer in men with urinary symptoms or suspicious digital rectal examination findings, according to the cancer society’s web site.

So wait, let me think about this for a minute…the test is “especially useful” for monitoring prostate cancer that has already manifested, and doctors recommend its use as a screening method for patients. But because there’s not demonstrable evidence that early detection of prostate cancer correlates with lenghtened life expectancies, the test — by all accounts, a common medical procedure — is thus inelligible for public funding? Tell me…when has early detection of cancer ever not benefitted the life expectancy of people? More to the point, why should it matter whether or not there is hard evidence that the test’s use has a significant impact on life expectancy? If it’s a common medical procedure and a cancer-detection mechanism, it should only make sense in Canada’s environment that it be elligible for public funding.

What’s perhaps even more galling is that the same logic would not be applied by the B.C. human rights commission in regard to abortion funding — after all, very few abortions are done to save the life of the mother. If the evidence shows anything, it’s that abortion may even have adverse effects on a woman’s life expectancy, and yet abortion is still elligible for public funds.

“Ah,” the Reader may remark now, “but a woman has the right to choose, so of course abortion must be elligible for public funds.” Okay, fine…but we do live in a modern society with advanced medical capabilities. What about the rights of those who wish to be proactive about their health and about cancer detection? Do not all people, regardless of gender, have the right to receive the best in cancer detecting medical services, especially in those cases where the forms of cancer being looked for are gender-specific? And if so, and if cancer-detection methods that look for cancers which primarily or exclusively afflict women are elligible for public funds, why is that not the case for those detection methods which look for cancers which primarily or exclusively affect men?

Now, let me be clear on this: I don’t think that the HRC was the proper forum for this complaint. But then, I am also not surprised by the result; why should an activist body such as the B.C. Human Rights Tribunal acknowledge that men have the same right to access to medical care as women do?

Update: Welcome, Steynians and fans of the furious one, to my humble corner of the Interwebs.

Update: My wife points out to me that while in the USA the PSA is a very commonly used test, and has been since about 1990, it is not so common in Canada owing to its higher cost. Also, she notes that the presence of prostate cancer is fairly easy to detect, as it can cause uirinary issues and other tell-tale symptoms. She notes, also, that in her experience she has not heard of anyone who has died from prostate cancer; it can be treated fairly easily, and does not typically spread into other body systems. Finally, she notes that the PSA test is not the most efficient test out there; increased levels of prostate specific antigen are actually fairly common in older men and can indicate two or three other conditions apart from prostate cancer.

None of which actually argues against the idea that this test should be elligible for public funds, especially since in this case the doctor did in fact prescribe the test specifically for the purpose of an early warning against cancer (and especially considering that in other places in the world, it’s a common thing).

A better test could be — and probably should be — devised. But that’s no reason to push this detection method to the sidelines.