May 31, 2012


Experts disparage use of test for prostate cancer, but many men may reject advice (Brian Vastag, 5/29/12, Washington Post)

[T]he strong reactions stem from a fundamental divide between personal experiences with cancer screening and the statistical realities revealed by large studies.

"THE PSA TESTS SAVED MY LIFE!!!" one man wrote in an e-mail to The Post, calling the government task force a "death panel."

He was expressing a cancer narrative that runs strong in our culture. It goes like this: I got a cancer test. It showed a suspicious result. A biopsy (which snips out a bit of tissue) then revealed that I had cancer. I chose treatment. Surgery, radiation or chemotherapy got rid of the cancer. I'm cured now.

The test saved my life.

Well, maybe.

With prostate cancer, there's a problem with that story: There's often no way to know if a particular case would have been fatal if left untreated. That is, it's impossible to know if the treatment really cured you -- or if you would have lived a long life without it.

It's an unsatisfying -- and confusing -- reality of prostate cancer.

As Post medical writer David Brown reported last year, about 240,000 American men receive diagnoses of prostate cancer annually. But in more than half of those cases -- about 130,000 -- the tumors are localized and low-risk. That means the tumor is confined to the prostate and is growing slowly.

In December, a group of experts appointed by the National Institutes of Health recommended that men with this form of prostate cancer forgo immediate treatment. (This NIH panel also debated whether it was time to stop calling such tumors "cancer.") Keep an eye on it, they said, with regular doctor visits and tests. But don't immediately rush to have your prostate removed, which can cause incontinence, impotence and, in rare cases, infections and dangerous blood clots.

But because these low-risk cases are called "cancer," the natural reaction, instead, is this: Get it out. Operate. Give me radiation. Cure me.

Urologists, oncologists and surgeons offer these options to patients with even the lowest-risk tumors. They treat cancer for a living, so they tend to err on the side of giving treatment.

As a result, about 90 percent of men with the low-risk prostate tumors opt for treatment.

Posted by at May 31, 2012 6:08 AM

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