Celebrity cancer disclosures can drive PSA interest, with risks

Public disclosures of prostate cancer by well-known men can quickly push more people to look for health information, researchers writing in The Conversation say. The effect can help reduce stigma, but it may also give men an incomplete picture of who benefits from testing and treatment.

Brooke Nickel, Jeremy Millar, Katy Bell and Mark Morgan pointed to media personality Jeremy Clarkson, whose recent disclosure of a prostate cancer diagnosis was followed by a rise in visits to Prostate Cancer UK’s website by men checking their risk. They also cited author and broadcaster Stephen Fry, actor Ben Stiller and former U.S. president Joe Biden as high-profile men who have spoken publicly about their diagnoses.

The researchers said celebrity stories can bring attention to aggressive or metastatic prostate cancer and encourage men to discuss symptoms or risk with a doctor. That may be especially useful for men at higher risk who had not previously considered prostate health.

But they said the public message can become distorted because many prostate cancers grow slowly and would not cause symptoms or shorten life. Media coverage has tended to overstate the value of screening while giving less attention to uncertainty and possible harms, according to the researchers.

The PSA test trade-off

The main screening tool is the prostate-specific antigen, or PSA, blood test. According to The Conversation authors, the test can find some cancers earlier, but it can also produce false positives, leading to further checks when cancer is not present.

The PSA test can also detect tumors that would never cause harm if left undiscovered, the researchers said. Treatment or investigation of those cancers can expose men to side effects involving urinary, bowel and sexual function.

The authors said the evidence on PSA screening has changed as new reviews have been published. A recent Cochrane review found PSA-based screening probably reduces prostate cancer deaths across a population, but the benefit is limited.

According to that review, screening 1,000 men would result in one to two fewer deaths from prostate cancer over the long term compared with no screening. The reduction appeared only after long follow-up periods of 11 to 23 years in the trials reviewed, because many cancers found by PSA testing grow slowly.

The same review found that, per 1,000 men screened, 16 additional men would be diagnosed and treated compared with men who were not screened. The researchers said some of those men would probably have cancers that would not have caused harm.

Guidelines favor targeted decisions

The Conversation authors said updated evidence is affecting clinical guidance in countries including Australia and the United Kingdom. Draft Australian guidance is expected to recommend that men who request testing first receive information on benefits and harms, with separate advice for specific groups.

The UK National Screening Committee recommends a targeted approach for men ages 45 to 61 who have BRCA2 genetic variants and a family history of breast, ovarian, pancreatic or prostate cancer, according to the researchers.

Both sets of guidance support shared decision-making rather than broad population screening, the authors said. That approach asks men to consider age, family history, general health, personal preferences and tolerance for uncertainty with a health care provider before choosing whether to have a PSA test.

The researchers said celebrity disclosures can be useful when they start informed conversations. They cautioned that public awareness should not replace a discussion of individual risk, likely benefit and possible harm.

This story draws on original reporting from Medical Xpress.