Can Cancer Ever Be Ignored?

The article “Can Cancer Ever Be Ignored?” reveals a nightmare of sloppy science. P.S.A. testing poses zero risk. It is not invasive, not radioactive, not even expensive. It is treatment that poses risk. Failing to distinguish between these two entirely different things is bad medicine, bad policy, simply bad thinking. Obviously, we have lots of work to do.

We should be searching for better treatment options, better ways of distinguishing between aggressive and nonlethal cancers, better ways of identifying high-risk patients. But advising men not to be screened accomplishes nothing, except to relieve physicians of their responsibility to inform patients fully and treat them appropriately.

DAVID BERMAN,
New York

Good grief! Can this “bitter fight over prostate screening” really be happening? Does screening really come down to a question of do it or don’t do it? My own case is instructive. When I was 60, I had a P.S.A. measure a bit below the standard that can trigger a doctor’s call for a biopsy, but given my family’s history of prostate cancer and my physician’s physical-exam diagnosis, I was sent for a biopsy. The biopsy showed a quadrant of my prostate loaded with cancer and evidence that the cancer may have escaped the prostate gland into the surrounding area.

As a result, I received 30 days of tabletop radiation, followed by a radiation-seed implant. Ten years later I have few aftereffects from these procedures and am in overall good health. Had the P.S.A. measure not been done, I am not sure what my destiny would be. The question for me is not whether the P.S.A. test saves lives; the question is, What is the most successful method for treating prostate cancer once it is detected? The P.S.A. is just part of the diagnostic toolkit, not the demon it is represented to be in this so-called bitter fight.

JOHN P. MASON,
Colesville, Md.

People always respond to these articles with personal stories about how they were diagnosed with prostate cancer after a P.S.A. test and now they are alive and well many years later. What they all fail to understand is that large studies show that they are just as likely to be alive and well now even if they never had the P.S.A. test and were never treated for prostate cancer at all.

SRB,
Mansfield, Conn.,
via nytimes