Biden cancer diagnosis should be a teaching time – the health care blog

By Daniel Stone

The diagnosis of Joe Biden’s metastatic cancer brings together two controversial problems: PSA tests for prostate cancer and presidential policy. To understand what is at stake, the Americans need fundamental information on PSA tests and a frank discussion of reasoning behind prostate cancer decisions in the case of the former president. The information dribble that we have obtained only makes more uncomfortable questions for Biden and his family. The absence of adequate explanation does not manage to contribute to the public’s appreciation of these important medical problems.

The prostate, a walnut -shaped gland at the base of the bladder, produces a “specific antigen of the prostate” or a PSA. Chemically classified as glycoprotein, an aggregate of sugar / protein, it escapes prostate in the blood, where its level can be measured with bloody routine tests.

As men age, the prostate enlarged, increasing PSA levels. Screen tests take advantage of the fact that prostate cancer generally discloses more PSA than normal prostate fabric. And in the case of prostate cancer, the PSA generally increases relatively quickly.

Beyond these basic facts, the story of PSA becomes blurred. Although a high PSA can report cancer, most men with high PSA have a benign prostate increase, not prostate cancer. Worse still for screening, many men with prostate cancer have a light and slow disease that requires no treatment. They coexist with their illness rather than die. This fact leads to the old adage that prostate cancer is the disease of long -lived popes and judges of the Supreme Court.

Medical advice panels consider PSA screening with skepticism partly due to the challenges of the benign elevations of the PSA of those related to cancer. Confirmation of a suspected cancer diagnosis requires prostate biopsies that can be painful and can produce side effects. In addition, once a diagnosis has been made, patients who could have coexist with their disease can unnecessarily be subject to treatment damage, such as radiotherapy and surgery. Finally, the advantages of early treatment for prostate cancer were difficult to prove in clinical studies.

For all these reasons, medical advice panels have discouraged generalized tests or recommend a nuanced approach with a careful discussion of the risks and advantages between patients and their

Despite these concerns, the pendulum has changed more PSA tests in recent years. One of the reasons is that improvements in radiographic imaging, such as MRI, allow “active surveillance” which can follow early lesions for signs of propagation, allowing doctors to distinguish relatively mild cases of prostate cancer and those likely to progress. Interventions can then be directed more specifically to those at high risk.

In my medical practice, I was generally a defender of prostate cancer screening despite the controversy surrounding clinical advantages. My experience brings me to believe that early diagnosis improves the prognosis. But even without improving medical results, patients and their families still benefit from early diagnosis for planning. No one wants to be extinguished by a symptomatic disease at an advanced stage that limits clinical and live choices.

In the case of Biden, after a certain initial delay, a spokesman revealed on May 20 that there had been no PSA test since 2014, during the Vice-Presidency of Biden. The reasons have not been revealed.

Such a decision could have been justified on the basis of questions about the advantages and risks of PSA tests. However, given the importance of the health of a vice-president and a future potential president, he could have expected that doctors are mistaken on the side of more information. The omission invites speculations that the political implications of a limit or increase in PSA may have played a decisive role. More information about his latest PSA and the basis of the decision not to continue screening could rest such speculation.

In the past, the public has had an overview of the important medical conditions of unhappy diseases affecting the first families. Screening from colon cancer received increased attention after the diagnosis of President Reagan in 1985. Betty Ford’s public disclosure of his difficulties with alcoholism and the dependence on prescription drugs have contributed to the deactivation of the treatment of disorders related to the consumption of substances.

Biden’s disease also offers an opportunity. Consider that prostate cancer has the greatest risk of cancer mortality in the face of non-smoking American men. Transparency in the treatment of the state of the former president would serve the public interest in increasing its awareness and understanding of significant nuanced care decisions faced so many men.

Daniel Stone is an internal and in -office geriatrician of the Cedars Sinai Medical Group. This part was originally Posted in La Times