Tuesday, September 1, 2009

Prostate Cancer Overdiagnosis


One of the hardest things to explain to patients is the whole deal about overdiagnosis of prostate cancer in men. More than 1 million men in the U.S. have been diagnosed with and treated for prostate cancer since that test has been used. That would be good news, except for the fact that the "vast majority of these 1 million men did not benefit from early detection," according to a new study published in the Journal of the National Cancer Institute.

The bottom line is that screening for prostate cancer is of questionable benefit. Another 2009 study published in the New England J of Medicine, had the same findings...that screening for prostate cancer did not provide a mortality benefit. An elevated PSA is not specific for cancer and a significant number of men with PSA values under 4 have prostate cancer. It is not a very good test and tumors can be slow growing and of no health significance.

To add to the confusion, the American Urological Association (Society of Urologists) issued guidelines that PSA screening should begin in healthy men at age 40. Keep in mind that Urologists benefit greatly when men with elevated PSAs need imaging studies and biopsies. It is these invasive procedures that are considered "over treatment" in the other studies.

The US Preventive Services Task Force has concluded that the evidence is insufficient to make a recommendation for or against routine screening using PSA testing or digital rectal examinations. The US Preventive Services Task Force cites the current lack of evidence that early detection improves health outcomes and the potential harm that can result from treatment.

With these divergent opinions from major credible scientific organizations, you can see that this is very muddy water. Those of us who are in the trenches, taking care of patients, are left to try and explain the current science to men (impossible) and to make our best judgment about screening tests.

I do it, but I am less than comfortable with the results.

26 comments:

Jonathan said...

I'm hoping that one day, within my lifetime and the sooner the better for us all, that science comes up with a test that is able to distinguish between slow growing prostate cancer that you'll die with and an aggressive prostate tumor that you'll die from.

Toni Brayer MD said...

Jonathan: I so agree

Patrick D said...

hello thanks for share this excellent information about Prostate Cancer Overdiagnosis, I think that this information about this important health topic is very useful and I would like to add some information about this topic: Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. There are currently[update] two methods used: One is the digital rectal examination (DRE), in which the examiner inserts a gloved, lubricated finger into the rectum to examine the adjoining prostate. The other is the prostate-specific antigen (PSA) blood test, which measures the concentration of this molecule in the blood.

The decision to screen has many controversies. Prostate cancer can develop into a fatal, painful disease, but it can also develop so slowly that it will never cause problems during the man's life. It is difficult for a man to tell how his cancer will proceed. On the other hand, treatment for prostate cancer with surgery, radiation or hormone drugs often leaves patients with sexual impotence and urinary incontinence and I have a question I suffer of prostate cancer and I also have Impotence and can I mix Generic Cialis and chemotherapy??? thanks for read my comment and I'm waiting your question

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first of all I am very thanks to Journal of the National Cancer Institute. I am regular reader of this Journal.

I was not aware about overdiagnosis of prostate cancer in men before reading this article. I am agree with author about increasing the rate of prostate cancer patient in the US. But I don't understand Why this happen what is basic reason behind such type of cancer.


Thanks for sharing this article I would like to read few more articles from you in near future.


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Prostate Cancer said...

Everyone is capable of having this disease. No exceptions. To prevent it, better do some research about prostate cancer, how to avoid it and other important details. If someone in your family has a history on having this disease, better do the prostate screening test and consult your doctor about it. Remember that knowledge is power.

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