Right to choose is important

EDITOR—Yamey and Wilkes argue that questioning cancer screening, specifically prostate specific antigen (PSA) screening can be a risky business in America.1 My prostate cancer, like so many others, was silent and only revealed after a PSA test that my daughter nagged me into adding to my biennial company medical examination—unfortunately too late to guarantee a cure. After surgery and adjuvant radiotherapy I probably have a better prognosis than two colleagues who presented with bone metastases (and PSA values, when tested, in the 100s).

My PSA result alerted me to a potential problem and let me enter an informed debate with the medical profession—no one forced me to have a biopsy, or an operation, or opt for surgery over radiotherapy, or decline hormone therapy, or do nothing. I could talk to my doctors, read books, and use the internet. I could assess the risks and benefits of a radical prostatectomy and, what is more, carry out this assessment against the background of a medical profession uncertain as to the best course of treatment for someone presenting with my results.

The key issue is that I could participate in making a life threatening personal decision, rather than have participation (and, by extension, timely treatment) denied to me because PSA screening had been ruled out for the entire male population on the basis of historical statistics. I am enough of a cynic to believe that some of the uncertainty surrounding PSA testing policy in the United Kingdom relates to resources.

During my decision making process, I came across a paper on dilemmas in treating early prostate cancer.2 It was easy to work out that there just aren't enough experienced urologists (who are dextrous enough to carry out this tricky operation successfully and have the courage to attempt it) to carry out …