New research is worth a look
Twice recently (Nov. 1 and 29) The Vindicator has published extensive reports, complete with sidebars and color photos, about a local “Prostate Cancer Awareness” promotion, which is designed to stimulate men over age 40 to get tested for that disease regularly, with the intent to save their lives if they have the disease. However, careful examination of currently available scientific information tells us that those who favor that approach are barking up the wrong tree.
Here’s the problem: Research and decades of experience have proven that early detection of breast and uterine cancers cuts death rates in women. The notion that this approach would do the same thing for prostate cancers in men made sense, and early experience with the Prostate Specific Antigen (PSA) test gave reason for optimism. However, that hope has faded as better-quality research has been reported in the top medical journals. For example, an extensive, scientifically sound study reported in the prestigious New England Journal of Medicine in 2009 clearly showed that regular PSA testing and digital examination did not significantly improve the outcome for a set of many thousand volunteer subjects, as compared to a similar size control group.
It turns out that prostate cancer behaves differently from other kinds. A few men get a form of it that appears in middle life and tends to be fatal if not managed aggressively. Many more get a kind that appears later in life and may never cause symptoms or risk to life. “Screening” of apparently healthy men in their 40s and beyond thus picks up some who need costly, aggressive diagnosis and treatment to determine if they really have a problem malignancy, as well as others with cancer that will never bother them. A decision for or against specific diagnostic study should be based on clinical judgment, not a shotgun approach.
As so often happens these days, the underlying driver of this conflict is money. American healthcare is by far the most expensive (per citizen) in the world, but our average length of life is nothing to brag about. Medical expenditures in the U.S. are a major cause of all the turmoil about our struggling economy and burdensome taxes. The prescribed care of prostate cancer is costly. It is urgently important that we not get sucked into paying staggering amounts for the diagnosis and treatment of that which does not need to be diagnosed and treated.
Robert D. Gillette MD, Poland