Prostate cancer debate
Posted: Tuesday, August 05, 2008 1:35 PM by Barbara Raab
By Robert Bazell, NBC News Chief science correspondent
Very few topics in medicine create more emotional debate and confusion than prostate cancer.
The latest position statement from the U.S. Preventive Services Task Force that men aged 75 and above need not be tested for the disease is the latest shot in an ongoing war among many factions who hold various positions on this disease. The task force, set up by Congress to try to set standards of care for American medicine, has said there is not enough evidence to say one way or another whether men under aged 75 should be tested.
Other organizations think that this position is outrageous and dangerous. They point to an approximately one-third drop in the death rate from prostate cancer (adjusted for the aging population) over the past decade, and see this as a triumph of extensive testing and the treatment that often follows.
At its core, the arguments about prostate cancer stem from our ignorance of much about the biology of the disease. Biopsies of men who died of other causes show that most men develop prostate cancer before they die and most of the time the cancer grows so slowly that it would never threaten a man’s life. But there are a large minority of prostate cancers that grow rapidly, spread throughout the body, most often to the bones, and cause a painful death.
The argument about testing is that testing, starting with a blood test called PSA and continuing with a biopsy, often finds the non-life threatening cancer. But men get treated anyway and often the treatments, be they surgery or radiation, often leave men impotent or incontinent or both.
What is needed are better methods of differentiating the cancer that is truly dangerous and needs to be treated, from the cancer that poses no risk. Such research is underway. Meanwhile, the National Institutes of Health has been running a study of 74,000 men since 1993, trying to determine whether screening saves lives. So far, it has not come to enough of a conclusion that the results have been released.
As with so many other aspects of this disease, men and their doctors must decide for themselves.
