One more note on medical knowledge controversy: e.g. PSA

I tried not to think too much about my PSA reading and prostate cancer, but I can’t. So, this weekend, I went back to Griffith, worked out in the gym, went swimming, doing what I can to relax.

Last Friday, I went to another GP recommended by a fellow PhD friend. The new GP admits since she’s not a specialist she doesn’t know the normal PSA level, and then she rang her urologist colleague and checked the facts.’Well, your PSA level is very high, but I guess it’s prostatitis, not aggressive prostate cancer.’ But of course, in the world of statistics, the probability is not zero. 

She asked me to do the urine test, and gave me a referral letter to the urologist in the CBD. I asked whether it’s necessary for me to do the MRI scan, but her reply is: let the urologist decide. ‘If the urologist thinks it’s necessary to do the MRI scan, you don’t need to pay. Otherwise, you’ve got to pay A$1000 if you go there on your own. You can throw away that referral letter for MRI scan.’

So, this week, rather than focus on my PhD confirmation seminar and Bernsteins, I read ‘prostate cancer’, ‘PSA’, ‘PSA in 30s’, etc. voraciously. I’m supposed to download the relevant academic journal articles in the area of critical policy studies but it turns out to be all articles in relation to medicine accessed through Griffith Library. Shit, a lot of distractions. (But I’m lucky that as a PhD student I can access a lot of quality journal articles on PSA and prostate cancer. That’s the reason why open access is so important!)

OK. I now found something rather interesting while googling ‘prostate cancer in 30s’. There is one press release made by the Urological Society of Australia and New Zealand on 7th November 2013, entitled ‘GPs should not be testing men for prostate cancer in 20s and 30s: Urologists’, with a headline ‘Society rejects Cancer Council claims of overtreatment’. (The link is here.)

I’m trying to use the actor-network approach to understand the whole thing. Here, there are at least some inconsistencies in terms of PSA screening amongst five professional bodies: the Urological Society, the Prostate Cancer Foundation of Australia, the Cancer Council, the College of GPs, and the College of Pathologists. They are all key ‘actors’ (one may even say that this number called ‘PSA’ is also an ‘actor’), but there are no ‘consistent testing guidelines’. 

For people like me who don’t have any training in medicine, we often believe that all doctors are ‘professionals’ and know the best for their patients, and we should all follow doctors’ advice. Here, I didn’t think the first GP did anything wrong. On a closer look into the case, we can see that these ‘actors’ (GPs, urologists, etc.) actually have different opinions. This reminds me of the actor-network theory (ANT) or actor-network approach I’m introduced to recently.

Actor-network theory

Strictly speaking, it’s not a theory. It is a methodological approach not just in sociology but in a range of disciplines, including public health. In this approach, an apparently weak and isolated item (e.g. in Bruno Latour’s anthropological study of laboratory life, a flask, a paper, etc., and in my case, a mysterious indicator called ‘prostate-specific antigen’ [PSA]) can acquire enormous power because of the complicated network of other items (‘actors’) that were mobilised around it, e.g. urologists, GPs, cancer foundation, etc. The more socially ‘networked’ a fact was (the more people and things involved in its production, e.g. the production of ‘PSA’ as an indicator for prostate cancer), the more effectively it could refute its less plausible alternatives. Here, obviously, from the statement made by the Urologist Society, PSA screening is rather controversial, and there are disagreements among the five professional bodies identified in the media release. 

In Latour’s view, science was ‘social’ not because it is created by human beings, but science brought together a multitude of human and nonhuman entities and harnessed their collective power to act on and transform the world. In the past, nobody did the PSA test, but now, as more and more people are doing it and are alarmed by its reading, it has harnessed enormous power to transform the way we look at our health. 

To Latour, scientific facts should be seen as a product of scientific enquiry. Facts are ‘networked’, but they are not regarded as ‘fabrications’, a position taken by the New Age movement. they stood or fell not on the strength of their inherent veracity but on the strength of the institutions and practices that produced them and made them intelligible. In the controversial case of PSA, in Basil Bernstein’s words, the boundaries between these key actors (i.e. the Urologist Society, GPs, etc.) seem quite strong, and thus, the confusions made upon the patients. If the networks break down, the facts still remain. That means, there is a possibility that I have prostate cancer in 30s. Touchwood. 

So, I’m not saying that I shouldn’t worry. In fact, this consistently high level of PSA reading gives me so much anxiety these days. 

Next Thursday is going to be my big day. In the morning, I will see the urologist, and in the afternoon, my confirmation seminar. Fingers crossed. 

2 thoughts on “One more note on medical knowledge controversy: e.g. PSA

  1. Don’t worry! Probably it is a small problem. It is quite common for men at a certain age. Anyway take care!
    Btw quite interesting to perceive PSA screening in this wayhaha

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    1. Hope so. I will have the MRI scan on Friday this week. Will see the urologist on Monday. I just recently pick up some social theory to understand public health. There is so much space for dialogue.

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