Radical Regrets: Prostate-Specific Antigen Testing, Surgery, and the Role of Affect in Therapeutic Reversals

• In Event: Emotions and Affect in STS Work - II: Science, Technology, Medicine, and Affect

Abstract

To surgically cure men of prostate cancer by wholly excising the walnut-sized gland was an ambition pursued with increasing regularity throughout the twentieth century. At the peak of the procedure’s popularity, 400,000 operations were performed in the U.S. each year. The prostate-specific antigen (PSA) assay, commercialized in 1986, figured centrally in this history. Worry about not intervening early and aggressively enough was countered with increasing insistence by commentators troubled by the limited benefits provided by costly surgeries and the sexual and urinary harms they produced. By the close of the 20th century, nationwide use of prostatectomies was declining and several doctors and researchers influential in promoting PSA testing publicly expressed regret for contributing to an era of perceived surgical overuse.

This paper analyzes the affect-laden debates surrounding the introduction of the PSA test and the prospective and retrospective judgements of actors involved in its approval process. Published reports, FDA transcripts, and interviews with key actors reveal complex epistemic, ethical, and emotional dynamics concerning the value and harms of surgery, standards of evaluating efficacy, and construction of medical information and uncertainty. The paper argues that affect served a critical function in the regulatory review by locating responsibility for regret in the clinical encounter. Drawing together recent work in social studies of medicine and the history of emotion, this paper contributes to understating the role of affect in the history of cancer by considering not only hope and fear, but also regret has shaped contemporary cancer care.

Author

• Jacob Moses, Harvard University