Prostate cancer overtreated?
My story today about overdiagnosis and overtreatment of prostate cancer reignites a controversial debate about whether men should be screened for the disease.
In the two decades since a blood test became the prevailing screening tool for prostate cancer, more than 1 million men nationwide have been diagnosed with and treated for the disease—most of them unnecessarily, a new study finds
The research, published in today's Journal of the National Cancer Institute, raises questions about whether the screening test -- known as prostate-specific antigen screening, or PSA -- does more harm than good. That may sound odd, since screening, on its face, seems beneficial. Catch cancer early and you'll live longer, right?
Well, not always. It's possible for people to have cancers that may never harm or kill them. When it comes to prostate cancer, many men are being diagnosed and referred to treatment that they don't need and that can actually cause harms such as incontinence and impotence, the study says.
Some urologists are pretty upset at the findings and think the study is misguided. They say it dismisses that PSA testing has helped doctors catch some cancers early and save lives.
With all the back and forth, men reading this are likely wondering: should I get a PSA test or not?
Well, that's a tough question to answer. The American Cancer Society and the U.S. Preventive Services Task Force don't recommend the screening but the American Urological Association does. The study's authors aren't advising for or against the PSA test, but they do stress that patients become informed and have conversations with their doctors about the risks of screening and possible treatment. Knowledge is power.
Comments
I am stunned and angered at the misleading information published by Dr. H. Gilbert Welch over the benefits of PSA testing. PSA testing is what has saved my husband's life. After having a PSA score of 3.3 in 2008 and 3.7 in 2009, we went to see a urologist in late July. My husband had no symptoms of physical problems whatsoever. After a biospy, prostate cancer was detected in its earliest stages and surgery will be performed very shortly. His long-term prognosis is excellent because he went and got his PSA tested every year. My husband is 55. I urge all men to get their PSA checked yearly. It will save your life. Lydia L. Kelly Baltimore
Posted by: Lydia L. Kelly | September 1, 2009 8:23 AM
Here's a very good article on the controversy:
http://www.drmcdougall.com/misc/2009nl/aug/king.htm
Getting your PSA tested and then having surgery is no guarantee your life will be saved and is no guarantee your life was actually in danger. But it IS a guarantee that you will likely become impotent, incontinent and have a marked decrease in the quality of life.
The fact is the research is not there to justify all the treatment going on, but it's very profitable for someone.
I pity the people who are having all this unnecessary treatment.
Posted by: Joe | September 2, 2009 3:04 AM
Any man interested in minimizing their chances of invasive prostate cancer — don’t use tDr. Gilberts opinions as an excuse to stick your head in the sand. His studies are already out of date. For a more realistic view of the admittedly difficult area of what to do about your potential prostate cancer — check out the recommendations of the experts on prostate cancer — the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN). They both have recent monographs reviewing the truth about PSA, it’s positive and negative characteristics, what to do and when but most of all don’t forgo PSA testing — it can and does give many men very important, life defining information.
Posted by: Lee Smith | September 2, 2009 8:23 AM
I thought it was interesting that the page story one downplays the importance of PSA testing and the page eight story features a picture of the Lockerbie bomber in the terminal stages of Prostate Cancer.
The issue seems to be that conventional treatment methods, with associated complications, are worse than the disease.
Proton therapy treats the cancer with virtually no side effects. It is unlike conventional radiation therapy, which enters the body like a bullet, damaging tissue on the way to and from the treatment site. Protons can deliver most of their energy at the target, sparing healthy tissue, because of a phenomenon known as the "Bragg Peak".
Pioneered by Loma Linda Hospital in California in 1991, Proton Therapy is now available at centers throughout the US. As a Prostate Cancer patient, I would highly recommend the procedure.
Posted by: David McGuinness | September 2, 2009 9:56 AM
PSA testing for men has its advantages and disadvantages. It has been found that man undergoing PSA testing to avert prostate cancer, nearly fifty men have to go under treatments which was not needed and a some of such men would face grave troubles with the treatment. So one should take proper care and should have knowledge on it.
Posted by: jimmy | September 7, 2009 1:57 AM