Tom Faranda's Folly

Prostate cancer screening saves lives, right? Well, maybe not.

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by

Tom Faranda
in

The study below was widely reported yesterday.

A year or two ago there was another in depth study, with results indicating that mammograms don't lower the death rate for breast cancer.

Intuitively, it would seem that early detection of cancer should raise the survival rate. And of course other studies (for both prostate and breast cancer) seem to bear that out. And the "cure" rate for cancer has risen in recent years from on person in three, to one in two. Of course, i tell people they never really declare you "cured" of cancer until you die of something else…

 Prostate Cancer Screening May Not Significantly Reduce Deaths, Two Studies Find – washingtonpost.com

The PSA blood test, which millions of men undergo each year, did not lower the death toll from the disease in the first decade of a U.S. government-funded study involving more than 76,000 men, researchers reported yesterday. The second study, released simultaneously, was a European trial involving more than 162,000 men that did find fewer deaths among those tested. But the reduction was relatively modest and the study showed that the tests resulted in a large number of men undergoing needless, often harmful treatment.

Together, the studies — released early by the New England Journal of Medicine to coincide with presentations at a scientific meeting in Stockholm — cast new doubt on the utility of one of the most widely used tests for one of the most common cancers.

"Americans have been getting screened for prostate cancer because there is this religious faith that finding it early and cutting it out saves lives," said Otis W. Brawley of the American Cancer Society. "We've been doing faith-based screening instead of evidence-based screening. These findings should make people realize that it's a legitimate question about whether we should be screening for prostate cancer."

Other experts were more circumspect, arguing that the European study did indicate at least some benefit for some men, and that the U.S. trial could eventually confirm those findings as it follows the men for longer periods. But they agreed that the new findings should prompt patients and their doctors to discuss the risks and benefits of the testing.

Comments

2 responses to “Prostate cancer screening saves lives, right? Well, maybe not.”

  1. Rabbi Ed Weinsberg Avatar
    Rabbi Ed Weinsberg

    Greetings! In the past few days a number of men have proudly announced how the new studies recently announced in the Journal of Urology justify their decision to skip their annual PSA readings.
    First of all the European and American studies you have cited are not equally conclusive about the value of PSA test, which in part MIGHT be because of an assortment of design studies, due to populations studied in different European countries prior to the collective report
    At any rate, while the American study shows no more cancer deaths among those not given a PSA test up to 7 years earlier, compared with those tested, the European study indicates that 20% more men were alive after 9 years among those who had a PSA reading and appropriate followup treatment. One doctor commenting on this study states more time is needed before determining the long-term impact of not testing for and treating prostate cancer.
    Reasonable doubts about the value of PSA testing is not new. Its accuracy has long been contested since there are plenty of false positives and false negatives. However right now it’s the best measure we have (along with DRE) for confirming if a man MIGHT have grounds for asking for a biopsy to confirm he has prostate cancer.
    Yes we need greater accuracy and that’s likely to be available within a few years, since there as many as four more accurate biomarkers than the PSA , as animal experiments have already revealed. But we still have to wait for human protocols until finding something better for men.
    PSA’s will be of value as long as men and their doctors want to find out if they have prostate cancer and where indicated, are willing to proceed with a biopsy. However using a biopsy to finding prostate cancer is random, and is therefore like a needle in haystack: You can still miss cancer cells during biopsies, nor do we have definitive means to definitively test for how aggressive your prostate cancer tumor(s) is/are while still inside you. For now, though, biopsies, like PSA’s, are all we can really use to determine with reasonable accuracy if a man has prostate cancer or not.
    Until research scientists take care of these matters, even the head of the new US study states that the surveys are inconclusive. So just because news report headlines imply PSA’s and biopsies lead to hastening unmerited treatment, doesn’t mean it’s so. So men, keep getting your annual PSA and check it out with a followup biopsy if needed because your doctor suspects you have prostate cancer. This goes doubly for those who are in a high risk category such as African-Americans or any man who has a close relative (father, uncle, or brother) who already had prostate cancer.
    Just because men who did not take the PSA test in the large American study might not have a higher death count than those who did, should not daunt you from having yourself tested. In my view finding out if you have prostate cancer and if it is aggressive or not is critical to monitoring your health.
    Even after testing you can always hold off taking a specific treatment if you and your doctor feel it is not yet warranted. Once you determine you have prostate cancer, you can always decide not to do anything except watchful waiting as long as your cancer is closely monitored as accurately as possible. After all It may be that such monitoring will become more precise in the near future.
    Meantime there is more than your mortality to consider. Even if your cancer doesn’t kill you, make sure your prostate cancer doesn’t become more aggressive, metastasize, and lead to increased pain, if not death. Remember that ignorance is not always bliss and, besides, the life you save could be your own. It would be folly to think otherwise.
    Rabbi Ed Weinsberg (Sarasota, Florida)
    Author, Conquer Prostate Cancer: How Medicine, Faith, Love and Sex Can Renew Your Life (www.ConquerProstateCancer.com)

    Reply
  2. tom faranda Avatar
    tom faranda

    Rabbi ed,
    Thanks so much for your thoughtful note.

    Reply

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