Prostate-specific antigen screening

John Biehn

I read Dr Robert Burn’s letter on prostate-specific antigen screening¹ with personal interest, having recently been declared “cured” [of prostate cancer] 6 years after brachytherapy (radioactive iodine) treatment.

Given that my father had incidental prostate cancer later in his life, and considering myself to be at some increased risk, I enrolled in the multicentre SELECT (Selenium and Vitamin E Cancer Prevention Trial) study some 10 years ago. The purpose of the study was to test, in a double-blinded trial, the hypothesis that selenium or vitamin E might decrease the incidence of prostate cancer. (The study was abandoned when it was found that the incidence of type 2 diabetes increased with one of the drugs and the incidence of prostate cancer slightly increased with the other. Incidentally, on inquiry I discovered that I was in the double-placebo group.)

I further reasoned that if I did have the disease, being part of a study would result in fast-tracking to treatment. This proved to be the case when a modest increase in prostate-specific antigen screening tests year to year (although still less than 4) led to a biopsy and the discovery that I had the disease in both lobes. What to do? I was offered, of course, the full range of treatment options and considered myself to be a “poster boy” for brachytherapy, which seemed to me the best choice, with good outcomes and fewer side effects. On subsequent inquiry, I was informed by a study nurse that more than 100 cases had been picked up in the study (of more than 1100 participants) and that I was the only one who had opted for brachytherapy.

I must confess that the idea of “sitting on a touch of cancer” had little appeal to me as an option. My procedure was uneventful and “went very well,” in the words of my radiotherapist who performed the procedure. Side effects have been of the nuisance variety, with no performance issues, at least for a few years. (I now use Viagra for enhancement purposes, likely age-related I tell myself—I’m 73.)

Having been declared cured and now back in the care of my family physician for routine follow-up, I often wonder if I am among those thought by some to have been overtreated for minimal disease. We’ll never know. But I am pleased with the course of action I took and to call myself a survivor.