Simon Chapman built his career in the anti-smoking movement. He ran, for many years, an organisation called Action on Smoking and Health.
He then became a professor of public health at the University of Sydney. His current campaign is against screening for prostate cancer. He set out his case in a SMH article a few weeks ago and, it seems, has written a book on the subject under the name Let Sleeping Dogs Lie.
Chapman’s argument is that men should not have the PSA blood test to see if they have prostate cancer because it might lead to unnecessary treatment.
What happens is this – a PSA test that is higher than normal and stays there for a while is a pretty good indicator of prostate cancer cells in the body. That test is followed by a biopsy, taking samples from the prostate. The PSA score and the results of the biopsy are combined to try to get an indication of the prognosis of the cancer.
Based on that, a decision is made on treatment, most commonly surgical removal of the prostate. Chapman says that this usually leads to impotence and sometimes incontinence. I am not sure about his figures – he says 77% and 12%. Many surgeons use a “nerve sparing” technique which, according to my reading, gives a very good chance of maintaining potency. Still, there are significant risks.
Chapman then says that prostate surgery saves few lives – most men dying in their 80s have prostate cancer but they die of something else before that cancer gets them. They die “with” rather than “of” prostate cancer. There is no conclusive way of identifying the aggressive prostate cancer that will kill.
Chapman quotes a figure that of 50 men treated for prostate cancer only one would have otherwise died from it. I believe this figure is disputed.
He says that the average age of death from prostate cancer in Australia is 79.8 while the all-up average at death is 76 so “on average, men who die from prostate cancer actually live longer.” Can you spot the fallacy in this comparison? Chapman stops just short of the comment, which some anti-PSA campaigners make, that most men with prostate cancer are pretty old and so were going to die pretty soon anyway.
Chapman’s conclusion is “don’t even ask, you don’t want to know if you have prostate cancer because it might lead to unnecessary treatment.” (My paraphrase).
I have quite a few friends and acquaintances who have had prostate cancer treatment. I don’t now how many are impotent (blokes don’t talk about that sort of thing) but I know of none who regret the treatment, whatever the side-effects. They believe the treatment saved their lives and though they do know that it was not certain that the cancer would have killed them they say “now I know it won’t”.
Like most public health academics, Chapman has no medical qualifications. He is a sociologist. He has never faced a patient with a diagnosis of cancer. He has never faced a patient dying of cancer who he earlier persuaded not to have the PSA test. He has never faced a patient.
I have given all this a lot of thought and have read pretty extensively on the subject and discussed it with GPs and urologists. I do have regular PSA tests and if I had a high result that hung around for a while I would have a biopsy. Then, with the best medical advice I could get, I would decide whether to have treatment.
Chapman says we should not put ourselves in the position of having to make this decision. Ignorance is better.
