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Prostate Cancer - Overdiagnosed, Overtreated Study Finds

Posted by Jane Akre
Tuesday, September 01, 2009 11:48 AM EST
Category: Major Medical
Tags: Prostate Cancer, PSA Test, Men's Health, American Cancer Society

The PSA test may not be necessary and may lead to unnecessary treatments.

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IMAGE SOURCE: © WikiMedia Commons/ Created by US government agency National Cancer Institute

PSA Test

A new study suggests that mass screening for prostate cancer has done more harm than good.

Mass screening involves testing for prostate-specific antigen or PSA, a protein produced by the prostate gland.

That’s the problem – tests showing elevated levels of PSA are not specific enough to tell the difference between the majority of prostate cancers, that grow very slowly over a man’s lifetime, and those that are potentially fatal and require treatment.

"Right now we don't have that magic biomarker, so I think it is more important to try to reduce the number of deaths than to worry about over-detection," said Dr. Judd Moul, with the Duke University Prostate Center to US News.

The result – for every man who is successfully treated for prostate cancer, about 50 are treated unnecessarily, and treatment comes with its own complications from impotency to incontinence from the surgery and/or radiation.

PSA screening came into routine use in 1986 and since that time prostate cancer has risen in the U.S., according to a report in the Journal of the National Cancer Institute.

“The ideal screening test would have no effect on the number of cases," said study co-author Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Medical School's Institute for Health Policy and Clinical Practice says to US News.

Dr. Welch and his co-author, Peter Albertsen of the University of Connecticut, gathered data on prostate cancer collected by the National Cancer Institute. They found when looking from 1986 to 2005, that 1.3 million prostate cancers were detected that might not have been without the PSA test.

Of those patients, more than one million were treated with surgery or radiation.

Watchful Waiting

Besides risky treatments, many patients and their doctors opt for something called “watchful waiting.”

More common in Europe, the strategy led to practically the same survival rates when 342 men, who deferred treatment for eight years, were watched by doctors at Beth Israel Deaconess Medical Center, reports WebMD.

“Among those who held off on treatment, 98% survived. With immediate treatment, the rate of survival was 99%," says Dr. Martin Sanda, director of the prostate cancer center. But watchful waiting can involve anxiety over the uncertainty of the cancer diagnosis.

The Sanda study appears in the Journal of Clinical Oncology.

Recomendations

Dr. Moul recommends an initial PSA test at age 40, and then follow-ups if necessary as does the American Urological Association. The American Cancer Society recommends a PSA test at age 50. 

There are no obvious symptoms of prostate cancer besides frequent urination, which can also indicate an enlarged prostate.

Besides radiation and surgery, patients can also choose alpha blockers that relax the smooth muscles in the bladder neck, allow for the smooth flow of urine. Drugs such as Avodart and Proscar are used to shrink the gland.  Radioactive seeds can be inserted under the prostate to kill the cancer.

The American Cancer Society estimates more than 186,000 new cases of prostate cancer will diagnosed this year and 28,660 will die from the disease. #


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