HJAR Sep/Oct 2019

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2019 51 Tim Langford, MD Arkansas Urology In our fight against prostate cancer, doctors like me rely on one strong advantage—time. For some men, this cancerous tissue will never spread to vital organs or pose a serious risk to longevity, overall health, or quality of life. Unfortunately, that strategic advantage is lost, and the opportunity for metastatic malignancy swells, the longer a patient goes without or between prostate cancer screens. As we prepare for the 20th anniversary of the very first September that was set aside to discuss prostate cancer diagnoses as an urgent and national priority, I am reminded of this critical piece in the fight against a slow-developing, but pervasive cancer— time. Fifteen years ago, I set out tomake PSA screens so easy, it almost invited a doctor- patient relationship on the issue. I wanted my practice to be not only a leader in size in the state of Arkansas, but also in standard of care. To that end, we began offering free prostate cancer screenings to any patient who walks through our doors. In fact, we promote it. The prostate-specific antigen (PSA) is a protein secreted by the prostate into the bloodstream, and the PSA test measures it. Aprostate harboring malignant cancer cells will cause these protein counts to soar, but malignancy isn’t the only reason counts rise. Free PSA screens have helped us diagnose about 1,150 men with enlarged prostates. Enlarged prostates or inflammation (from infection, for instance) can result in PSA test scores that call urologists into action, but not all action is cause for alarm. Still, incidents of new prostate cancer cases in Arkansas are higher than average, with 111.6 new cases per 100,000 men, according to a recent count by the Centers for Disease Control. Meanwhile, at just under $46,000, the state ranks near the bottom nationally for median household income. About 17 in 100 Arkansans live in poverty. Preventative health care and cash flow are so intimately connected that one nonprofit institute found a “dramatic link between health care spending and tax refunds.” Namely, spending jumped 60 percent on out- of-pocket health costs the week after a household received a tax refund. Offering free PSA screens to thousands of Arkansans has helped bring men in for preventative care, who perhaps cannot afford it otherwise. Prostate health evaluations begin a process of consultation between doctor and patient that is critical for prostate health, regardless of results or prognosis, and important for patient self- care across a range of health concerns. Prostate cancer intervention should be viewed on the same continuum of care as breast or colon cancer. All three are common, sometimes fatal, and often 100 percent treatable with early detection. The Centers for Disease Control’s own National Breast and Cervical Cancer Early Detection Program offers free or low-cost mammograms and Pap tests nationwide. Some years ago, the U.S. Preventive Services Task Forcemade a recommendation against PSA screening because men with chronic prostatitis and benign prostatic hypertrophy can deliver false positives. A later recommendation walked this back, updating the recommendation in response to new research demonstrating the benefits of PSA screening (such as the European Randomized Study of Screening for Prostate Cancer). The consensus position is this: PSA screens are one among many findings that factor into the shared decision-making relationship between doctors and patients. The American Urological Association recently recommended that men ages 55 to 69 be offered the screening. The PSA test has come under medical scrutiny in recent years because of the range of etiological factors at play in elevated PSAs. That scrutiny has turned into controversy, unfortunately, both in the media and the medical community. The data collected in the course of administering free PSA screens to about 4,700 Arkansas men over the last 15 years leads me to the conclusion that offering free prostate screenings is a successful method of reaching men who otherwise would not be tested or continue to get care as needed. The PSA screen is just a test, a lab value, and it happens to be one we have found clinically effective. It is critical for early detection, but it is also useful for kickstarting a therapeutic dialogue about patient health and education. n Dr. Tim Langford has been with Arkansas Urol- ogy since 1993. Prior to joining Arkansas Urology, he served as chief urology resident at UAMS. Dr. Langford received a medical degree from UAMS, and graduated magna cum laude from Arkansas State University in Jonesboro with a bachelor’s degree in zoology. Dr. Langford is certified by the American Board of Urology. He is a member of the American Medical Association, American Urological Association, Arkansas Medical Soci- ety, and Pulaski County Medical Society.