Prostate cancer screening: What would Dirty Harry do?

So, to paraphrase Dirty Harry, “Do you feel lucky, punk?”

A couple of stories this week have put me in a philosophical state of mind, and when I start feeling that way, I think of Clint Eastwood’s Inspector Harry Callahan, one of my favorite philosophers.

In fact, Harry’s famous movie line was the first thing that came to mind when I read The Times’ story Monday on prostate cancer screening for men.

The headlines summed it up: “PSA test for prostate cancer should be dropped, task force says.”

“An expert advisory panel argues that needless treatments hurt many more men than are helped by early detection.”

Basically, it boils down to risk/reward. About 28,000 men in the U.S. will die of prostate cancer in 2012. But here’s what The Times story says about the PSA test:

At best, one life will be saved for every 1,000 men screened over a 10-year period, according to the U.S. Preventive Services Task Force. But 100 to 120 men will have suspicious results when there is no cancer, triggering biopsies that can carry complications such as pain, fever, bleeding, infection and hospitalization.

And if cancer is detected, 90% of men will be treated with surgery or radiation even though most tumors are not life-threatening.

Of 1,000 screened men, as many as 40 will suffer impotence or urinary incontinence as a side effect of treatment, two will have heart attacks or strokes and one will develop a dangerous blood clot in the legs or lungs, the task force concluded after a review of the scientific literature. As many as five of 1,000 men who undergo surgery will die within a month.

So, you can forgo the test and perhaps be one of the 28,000 who will die. Or you can have the test and undergo treatment, perhaps for nothing or perhaps with nasty side effects.

Do you feel lucky?

It’s an easy choice sitting there reading the newspaper; it’s not quite so simple sitting in your doctor’s office and hearing that you may have cancer.

But of course we make choices all the time that involve risks. It is, in fact, one of the things we as Americans cherish: Our freedom to take risks.

Which brings me to motorcycles. Or, as The Times reported Tuesday:

No progress was made last year in reducing motorcyclist deaths, even though overall motor vehicle fatalities dropped to their lowest level since 1949, according to the Governors Highway Safety Assn.

The group projects about 4,500 motorcycle fatalities for 2011, about the same as the year before.

Now, the safety association uses the data to argue for mandatory helmet laws. But, the story notes, such laws are under attack:

The report comes as seven states have repealed mandatory helmet laws since 1997, most recently Michigan, and legislation has been introduced in five other states to repeal their laws, according to the highway safety association.

Michigan officials who pushed for repeal argued that wearing a helmet was a matter of personal choice. They also contended that repealing the mandatory helmet law would boost the state’s tourism.

(I’m not sure what Michigan’s tourist slogan would be for that: “In Michigan, you can feel the wind in your hair -- and your brains on the pavement.”)

Personally, why anyone would argue against helmet laws is beyond me. So I’ll leave it to Pete terHorst, a spokesman for the American Motorcyclist Assn.:

“We do not agree with one of the report’s recommendations that mandatory helmet laws are a solution,’’ he said. “The AMA strongly encourages helmet use, but helmets do nothing to prevent motorcycle crashes.”

Well, duh. And seat belts and air bags don’t prevent car crashes either. But the safety stats certainly seem to show that (a) accidents happen, and (b) safety devices help you survive them.

But it’s about risk, right? How much risk are you willing to assume to feel that wind in your hair on the bike?

I wonder, though: How many of the motorcyclists who disdain helmets would tell their doctor: Don’t treat me for prostate cancer?

So, it’s back to Dirty Harry for the last word: “Do you feel lucky? Well, do you, punk?”

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