Let sleeping dogs lie? What men should know before getting tested for prostate cancer

Reviewed by:


Simon Chapman, Alexandra Barratt and Martin Stockler
Sydney University Press (2010)
ISBN: 978-1-920899-68-4
134 pages
RRP: AU$25.00

In the run up to the popular multi-cause fundraising activities of Movember, it is timely to draw attention to one of the causes covered under this umbrella – prostate cancer. When asked to review this book, I wondered exactly who it was written for. The authors take 14 pages to explain why they have written the book, but they don’t clearly identify the intended audience.

And that is disappointing. This small book is written for men, but which groups of men? Smart and educated men in my circle have been diagnosed with prostate cancer or have been worried by high PSA tests. Yet, when discussing the book with them, they suggested it might be best suited as an adjunct text for students of the health professions. These men all invariably asked for the simplified fact sheet or executive summary – they would not necessarily have read the academic discussion contained within. A shame – a missed opportunity to get a very pertinent and compelling message to the intended audience. How did this happen when the book was primarily penned by a life member and previous chairman of the Australian Consumer’s Association. Was the book ‘road tested’ by consumers (perhaps a few non-health ‘blokes’ at least) for uptake and usability?

If a critical point for men worried about prostate cancer is when they are seeing a general practitioner, then the GP at the point of examination needs to ensure they address that man’s unique history and factors that would warrant the path of PSA testing. I also wonder why the authors didn’t collaborate with peak bodies or professional groups to ensure GPs are exposed to this significant case against routine screening.

I had a problem with the use of the proverb in the title: Let sleeping dogs lie? (To not try to change a situation because you might upset the status quo). Does trying to be provocative and controversial in such a controversial space help?

It is a very compelling read though, because of the controversies – every health professional should consider its key message as a principle (what does the evidence tell us?) in their practice and in their influence personally. The case is built strongly through the chapters: What is prostate cancer and how common is it? What is the risk of dying from prostate cancer? What is the risk of being diagnosed? What increases or decreases the risk of prostate cancer? How is it diagnosed? What are the treatments for early stage? To screen or not to screen? And, some further questions and answers.

The most telling message came for me on page 61 when the authors quoted Doctor R Albin (who discovered PSA in 1970) who wrote forcefully, in 2010, describing the test’s popularity as “… a hugely expensive public health disaster …. the test is hardly more effective than a coin toss … it can’t detect prostate cancer and … it can’t distinguish between the two types of prostate cancer – the one that will kill you and the one that won’t…”

The authors make the point, as did Professor Ian Olver, writing recently in The Punch (6 September 2011) that the debate has been messy and personal, much like a dirty schoolyard brawl. “Raising awareness is a catchcry for cancer events. Prostate cancer awareness is complicated like no other cancer by the mixed messages on early detection.” The authors highlight some of the misinformation that has been ‘peddled’ of late in public media … often in conjunction with specific fundraising initiatives. We all need to mindful of these mixed messages – the public may have become wary and distrustful of ‘competing’ health professionals and organisations.

It is a useful and timely book. Download the PDF file free at: hdl.handle.net/2123/6835

The general messages men receive about prostate cancer are confusing and aimed at either routine screening or individual choice (depending on the ’authority’ giving the recommendation), despite the tenet of this book, that routine screening with PSA is not effective and that the key message of prostate cancer is that each man should consider his unique risks and hence the need for screening.

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