Prostate cancer screening

TESTING FOR PROSTATE CANCER IS ADVISED DESPITE STUDIES


Watch. Wait. Should I test or not test? Last week the results of two studies on prostate cancer screening were part of the headlines in The Arizona Republic. [3/19/09]

I read those studies, and I am concerned that men might get the impression that it is OK not to be given a prostate specific antigen test [PSA] and digital rectal examination [DRE].

The article concluded with this thought. “The two studies were designed to give a definitive answer about the value of such screening.” Not all researchers agree that the studies do this.

Overall one of every six men will get prostate cancer during their lifetime, most physicians recommend the PSA and DRE after age fifty. It is usually slow growing but it ranks as the fifth leading cause of death among men. At 50, your chances are 1 in 476 of having the cancer.

WHAT THE STUDIES MEAN

Dr. Ruth Etzioni in Biostatistics of the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center pointed out several issues that put the research in the proper context.

“The interpretations of the results of these studies are incorrect. In the American study, there were as many men who where screened in the non-screened groups as were in the screened group. In treatment research, one group gets the treatment and the other does not. You can then compare your results.”

In the American study, the figures are almost identical for the screened and not screened. 34.6% of the screened had a PSA test in the past 3 years and 34.3% in the not screened had the PSA test. The results of the DRE examination were 32.8% for screened and 31.9% for the not screened.

Etzioni says, “The American trial is not a study of true screened and not screened as was the European trial.” That is because nearly one third of the supposed “not screened” did have tests.

“There was too much focus on the American trial. You cannot just look at the number of deaths from prostate cancer, since not that many die from the cancer. You have to look at the percentage drop in the number of deaths for those who were screened. The European results showed a 20% drop in cancer deaths which I think is significant.”

PROSTATE CANCE IS SLOW-GROWING

Most prostate cancer is a very slow growing cancer that could take 15 years. The U.S. Preventive Services Task Force suggests that men over the age of 75 not bother with testing since life expectancy is shorter than the time it would take for prostate cancer to be your cause of death.

Most men who are diagnosed with prostate cancer are likely to die from something else before they die from that cancer.

When I was diagnosed with prostate cancer last November, only one biopsy of twelve actually contained cancer. After surgery, my surgeon told me that more than 90% of my prostate contained cancer. He also informed me before surgery that it was my decision to choose an approach. I could have chosen watchful waiting.

What you do not see in the media reports about the two large research studies, but is included in the New England Journal of Medicine, is that about 95% of male urologists and 78% of primary care physicians who are 50 years of age or older report that they have had a PSA test themselves, a finding that suggests they are practicing what they preach.

While I do not recommend that you read the two studies, I do recommend that you read the discussion by two physicians about the studies. The research may have been reported too soon. In the European trials, the researchers plan to continue beyond the current ten years.

MY PROSTATE CANCER EXPERIENCE

The results of my prostate surgery so far are very positive. One week with a catheter was followed by a full diaper pant for 2 weeks. An absorbent pad was needed for four weeks. Now there is no leakage. I took no drugs and have not experienced erectile dysfunction.

What I do not know and may not know for some time is whether I am cancer free. I will continue to be screened on a regular basis.

You must decide for yourself whether you wish to be screened and then whether to seek treatment. I made my decisions after a lot of study and consultation with friends who were diagnosed with prostate cancer.

Do not let headlines alone persuade you.



More Resources:

American study: http://content.nejm.org/cgi/content/full/NEJMoa0810696?query=TOC



European study: http://content.nejm.org/cgi/content/full/NEJMoa0810084?query=TOC


Physician Discussion of studies: http://www.nejm.org/perspective-roundtable/screening-for-prostate-cancer/?query=TOC



My blog on prostate cancerhttp://prostatecancersupport.blogspot.com/