Pepe the prostate speaks out the PSA, the USPSTF and prostate cancer-the rodney dangerfield of diseases

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Mr. PSA-“I have feelings too!”

Dr. John C. McHugh of Prostatediaries interviews PSA

Dr. McHugh: “So first of all thanks so much for coming on the program.”

PSA: “My pleasure. There’s been a lot of bad press out there and I appreciate the opportunity to respond.”

Dr. McHugh: “You look young. How old are you, if I might ask?”

PSA: I am about 24 years old. I really did not get popular until the late eighties.”

Dr. McHugh: “Well, let’s get to it. A lot of people are saying that you have somewhat saturated the market, that your value in the prostate community is waning. Many people feel that you are responsible for perpetrating upon the male population a bunch unnecessary misery. I guess you have become fairly thick skinned over the years.”

PSA: “I really don’t know where to start. You know it’s not like I am forcing myself on people. There are about 30,000 deaths from prostate cancer a year in the United States and it is the most common tumor in men. I help find it and hopefully in many cases detect it early and save lives. It’s all about early detection in cancer you know.”

Dr. McHugh: “Do you think all this recent press about you and over diagnosing cancers that don’t need to found or treated in the first place is a jealousy thing.”

PSA: “You make a good point. The breast and the colon, and for that matter the lung, would kill for a marker that could be done with a blood test and facilitate the diagnosis of cancer in them earlier.”

Dr. McHugh: “For our “new listeners, tell us a little about yourself.”

PSA: “I am glad you asked. I am a subsidiary of the prostate gland. Man, God had a sense of humor when he created that thing. It gets bigger as men age and serves no purpose but to cause problems by either turning into cancer or enlarging to the point that men can’t pee. The very thing or other organ that men would hope to get bigger actually gets smaller and quits working. Go figure. Anyway, be that as it may, the cells in the prostate normally produce a product like me, but prostate cancer cells produce more of it than they do. So if I am elevated in the blood there is the possibility that there are cancer cells producing it, i.e. the man has prostate cancer. I’m probably the most specific marker for cancer there is.”

Dr. McHugh: “But isn’t the problem that you are elevated sometimes when there is not a problem. “You “cry wolf to often” so to speak. Do you agree with that statement?”

PSA: “Cry wolf, wow that is choice.”

Dr. McHugh: “False positive readings, you are high and there’s no cancer. Lots of unnecessary pain, money, tests and emotional upheaval because of you man. What do you say to that?”

PSA: “What do you say about Jesus leaving the 99 sheep to find the one?”

Dr. McHugh: “Insurance companies would beg to differ. They would ask,” Who is going to pay for the 99 if they are lost? They’d put their time and effort in the 99. It is not cost effective to lose 99 sheep to save one. You’d agree with that wouldn’t you?”

PSA: “Hey, don’t shoot me. I am just the messenger!”

Dr. McHugh: “So what’s in it for you? Are you making money on this? Is the prostate behind this?”

PSA: “The prostate? Are you serious? It’s the male patient. He’s the conductor driving this train my friend. Then there is the doctor who will be sued if he misses a prostate cancer in a male patient because he did not use me. You see that don’t you. Visualize your brother going to the doctor for bone pain and prostate cancer is detected all over his body and the doctor had not used me, Mr. PSA, to help make sure that he did not have prostate cancer. I was not used because the doctor did not want to put your brother through the anguish of obtaining me and possibly subjecting him to a prostate biopsy. He was doing your brother a favor. The doctor spent twenty minutes on the informed consent about me and how it might lead to unnecessary tests and pain and your brother who doesn’t like the thought of rectal exams anyway declined the evaluation thinking he was smart, medically progressive. He’d read the news reports everyday about how bad I am. It was easy, “No, I don’t want a rectal exam, the blood test or any of the stuff that goes with it. Stuff that happens in prison all the while running rampant through his mind as the doctor is talking and giving him his options. He remembers a friend telling him that his father was 90 when he died of prostate cancer and the doctors,” didn’t even treat it.”

Dr. McHugh: Well PSA, you sound somewhat defensive to me. Biblical allusions, sarcasm and then, trying to personalize your point by referencing a family of mine to make your point? What’s up with that, are you angry?”

PSA: “In a way I am. If I asked you, if you were the lost sheep, would you want to use me to find you; even if it meant searching through the other 99 to find you? How do you feel about that? How would you feel if it were you that we were trying to save earlier? Would you be concerned about the time, effort and cost it took to save you? That my friend, is the question and the dilemma we find ourselves in. Tell me about how you would feel if it were you! Think of the old time worn and tested saying, “Follow the money, there is the answer.”

Dr. McHugh: “That is all we have time for tonight. Please join us next time for Part Two of my interview of PSA. Good night all.”