Screening debate typifies prostate cancer uncertainties

August 10, 2012 By Serena Gordon, HealthDay Reporter
Screening debate typifies prostate cancer uncertainties
Experts differ, leaving men with no easy answers.

(HealthDay) -- Though prostate cancer makes the news a lot, much of the information seems conflicting or inconclusive, leaving men with few absolute answers.

Which treatment is most effective? Which has the fewest side effects? And who might benefit most from for ?

The dilemma posed by screening perhaps typifies the haze surrounding prostate cancer issues.

"The problem with screening is we know that you have to screen a lot of people and treat a lot of people to prevent one death," explained Dr. Ian Thompson, director of the and Research Center at the University of Texas Health Science Center in San Antonio. "Right now, you have to screen at least 1,000 men and treat between 20 and 50 to prevent one death. That person unequivocally benefits from screening, but at the same time, many men were treated who didn't need it."

That's key because the risks of screening aren't trivial, he said. The possibility of a false positive is significant, and that finding then leads to a biopsy, which can cause excess bleeding or infection. It's also possible to find a cancer that may have been inconsequential, so screening can lead to overtreatment.

Complications from treatment also may include surgical complications, urinary incontinence and sexual side effects.

"Now you have a man who has to take Viagra or who becomes sexually inactive, or who has or other complications, and those are significant," Thompson said. "And, while those complications may seem small compared to saving a life, there are far more people affected by complications than people saved."

Ruth Etzioni, a and researcher at the Fred Hutchinson Cancer Research Center in Seattle, agreed.

"The reason why people can't come to an agreement about screening [for prostate cancer] is that it's not all good," Etzioni said. "It's costly and it can harm many more men than it's saved."

"Older men won't benefit from prostate cancer screening," Etzioni said. "They're much more likely to die of another cause. There really is a consensus that older men shouldn't be screened. But, there are still doctors performing the test in older men or older patients who are asking for it."

For younger men, there's no consensus on what to do, said both Thompson and Etzioni.

The latest recommendation from the U.S. Preventive Services Task Force is that there's not enough credible information available to recommend screening for prostate cancer with the prostate-specific antigen (PSA) test for any man, regardless of age.

Not everyone agrees with that recommendation, however. The American Society of Clinical Oncology advises men with a life expectancy of more than 10 years to talk with their doctors about their own individual risks and benefits from a PSA screening test. For men with a life expectancy of less than 10 years, the organization believes that the risks of the PSA test probably outweigh its benefits.

Men with a higher risk for prostate cancer may benefit from screening with the PSA test, according to Thompson. One factor that increases risk is having first-degree relatives -- father, brother, son -- with prostate cancer. The more relatives with the disease, the greater a man's risk. The other significant risk factor is race. Blacks have double the risk for prostate cancer, compared with whites, Thompson said.

However, most people who develop prostate cancer have no risk factors at all, he said.

Etzioni said it's important to keep the odds of dying from prostate cancer in context.

"The chance that you'll die of prostate cancer is rare," she said. "The chance that something else will kill you is much higher." Men's health would be better served, she said, if they spent more time exercising and eating healthy.

Thompson said he wished men would do at least the same amount of due diligence in deciding whether to get a prostate cancer screening as they do when they're going to buy a major appliance or a car.

"The take-home message is what really ought to happen is that people should become educated," he said.

That advice also holds true when men with prostate cancer have to choose which treatment is best for them, he said. Common options include active surveillance, surgery, radiation and hormone therapy.

When it comes to choosing an individual treatment, both Thompson and Etzioni said that most of the common treatments appear to be similarly effective so the decision may come down to the potential side effects of each treatment.

"There are important side effects from treatment that can affect quality of life, and they're not infrequent," Etzioni said.

Often, though, that decision "may be more of a gut feeling than an intellectual decision," Thompson said.

For men with slow-growing cancer, both experts said that active surveillance -- sometimes called watchful waiting -- is often a reasonable alternative to other treatments. The condition is monitored closely but not treated unless it progresses.

with more aggressive cancers may need to combine treatments to get the best results, Thompson said. Those who choose radiation to treat such cancer, he said, usually have better outcomes when they also have hormone therapy. For those who choose surgery for an aggressive cancer, results will probably be better if radiation is added to the treatment, he noted.

Explore further: Expert panel suggests PSA test may benefit some men

More information: The American Urological Association Foundation has more on prostate cancer.

A companion article looks at how one man dealt with treatment options.


Related Stories

Expert panel suggests PSA test may benefit some men

July 16, 2012
(HealthDay) -- Men with a life expectancy of more than 10 years should talk with their doctor about getting a prostate-specific antigen (PSA) test for prostate cancer, an expert panel recommends.

Recommendation against PSA test too drastic: WU expert

May 22, 2012
(Medical Xpress) -- A new recommendation issued today by the U.S. Preventive Services Task Force against routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer ...

Recommendation against PSA test goes too far: expert

October 12, 2011
(Medical Xpress) -- A draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer ...

PSA screening to detect prostate cancer can be beneficial to younger and at-risk men: study

May 7, 2012
Screening younger men and men at risk of prostate cancer can be beneficial in reducing metastatic cancer and deaths and should not be abandoned, states an article published in CMAJ (Canadian Medical Association Journal).

Benefits of prostate-specific antigen testing remain unclear

July 20, 2012
(HealthDay) -- It remains unclear whether the benefits of prostate-specific antigen (PSA) testing outweigh the harms, but evidence suggests that men with a longer life expectancy may benefit from testing, according to a provisional ...

Recommended for you

Outdoor light at night linked with increased breast cancer risk in women

August 17, 2017
Women who live in areas with higher levels of outdoor light at night may be at higher risk for breast cancer than those living in areas with lower levels, according to a large long-term study from Harvard T.H. Chan School ...

Scientists develop novel immunotherapy technology for prostate cancer

August 17, 2017
A study led by scientists at The Wistar Institute describes a novel immunotherapeutic strategy for the treatment of cancer based on the use of synthetic DNA to directly encode protective antibodies against a cancer specific ...

Scientists develop blood test that spots tumor-derived DNA in people with early-stage cancers

August 16, 2017
In a bid to detect cancers early and in a noninvasive way, scientists at the Johns Hopkins Kimmel Cancer Center report they have developed a test that spots tiny amounts of cancer-specific DNA in blood and have used it to ...

Toxic formaldehyde is produced inside our own cells, scientists discover

August 16, 2017
New research has revealed that some of the toxin formaldehyde in our bodies does not come from our environment - it is a by-product of an essential reaction inside our own cells. This could provide new targets for developing ...

Cell cycle-blocking drugs can shrink tumors by enlisting immune system in attack on cancer

August 16, 2017
In the brief time that drugs known as CDK4/6 inhibitors have been approved for the treatment of metastatic breast cancer, doctors have made a startling observation: in certain patients, the drugs—designed to halt cancer ...

Researchers find 'switch' that turns on immune cells' tumor-killing ability

August 16, 2017
Molecular biologists led by Leonid Pobezinsky and his wife and research collaborator Elena Pobezinskaya at the University of Massachusetts Amherst have published results that for the first time show how a microRNA molecule ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.