For men of a certain age getting a PSA blood test -- to check for possible prostate cancer -- is an annual affair. If you're over 50, chances are you've had the test and if you haven't it's not because your doctor didn't mention it.
Now comes the United States Preventive Services Task Force that says the test doesn't save lives and can cause great harm.
About a quarter million men in the U.S. will be diagnosed with prostate cancer this year and there will be about 34,000 prostate cancer deaths. It afflicts older men (if you're male and live long enough you'll probably end up with it), blacks more than whites and those with a male family member who has it are more susceptible to getting it.
For those diagnosed with prostate cancer there are treatments but here is where the task force starts to put the questions into the equation.
Some of the prostate cancers are so slow-growing that they will never impact the man's health. Some of the procedures to eliminate the cancer can cause incontinence, lack of sexual function and pose other problems. Many men endure life-altering procedures that may or may not prolong their life and quality of living.
What a diagnosis of prostate cancer does is just show us what we don't know -- will it be aggressive and life-threatening or so slow-growing we can just forget about it.
It's the forget about it part that's hard for most people to reconcile.
For decades the process has gone this way: Cancer detected, surgeon and oncologist consulted, cancer cut out, irradiated or poisoned or a combination of the above. Sitting back to wait and see what happens is not standard operating procedure by a long shot.
Added to the quandary for men is that the PSA test is anything but a slam dunk -- it merely measures the level of an enzyme in the bloodstream that is given off by the prostate with an arbitrary level where a cancer may be present. Once that threshold is passed comes a biopsy and then decision time.
The task force's findings follow its study two years ago questioning mammograms for some women and also suggesting PAP tests for cervical cancers be changed from once a year to every three years.
A news analysis in The New York Times recently provided some explanation of the stances the group has taken.
Of special interest was Dr. Otis Brawley, chief medical officer of the American Cancer Society, who noted that cancer was defined in 1845 by German doctor Rudolf Virchow who said cancer was an uncontrolled growth that spreads and kills. But Virchow only saw cancers at autopsy and not the ones that didn't grow or wouldn't have killed.
As Brawley put it, "We are going from an 1845 definition of cancer to a 21st-century definition of cancer."
And in the meantime there is the fallout -- what's a man to do? Or in the case of mammograms and PAP tests, what's a woman to do?
You can expect some physicians will be getting plenty of questions concerning the tests, as they should.
Especially important is that sometime cursory take on the family medical history. For a doctor to make an informed decision it's vital to have that family history available.
A case in point: I know of one family where the women had the gene that basically promises they will get breast cancer. Their mother, grandmother, great-grandmother and aunts all died of it. Certainly given that background, the test for the gene and ongoing mammograms is a must; many women faced with that prospect have prophylactic mastectomies.
And there are families where the men are plagued by prostate cancer -- certainly the PSA is a worthy test for them.
Beyond that the benefit of such tests gets murkier and murkier.
We might "want to know" if we have cancer, but there are plenty of questions that a simple screening test won't answer for us. Medicine isn't quite ready to take us to that 21st-century definition of cancer and what to do about it quite yet.
Which is of no help when you go face to face with your internist.
So what's a man to do?
Kendall P. Stanley is retired editor of the Petoskey News-Review. He can be contacted at firstname.lastname@example.org.