What are the dangers of prostate screening?
Should you treat prostate cancer, or just let it go?
Here’s something to keep in mind.
About 80% of men who reach old age and die, have prostate cancer.
In most cases they don’t even know it.
It’s rare that they die from prostate cancer.
Prostate cancer is probably the most overtreated and disastrous cancer diagnosis for men right now.
But why wouldn’t you treat prostate cancer?
Cancer is a scary, deadly thing, right?
Well, not as much in the case of prostate cancer.
I hope this newsletter helps clear up some of the confusion.
Let’s start with this study of 6630 man who went through PSA and digital rectal exams.
The first thing to realize is that a positive result does not indicate cancer.
A positive result would be a high PSA or something suspicious on the rectal exam.
Positive predictive value was 32% for PSA and 21% for digital rectal examination
So most of the time, when they say you might have prostate cancer, it’s a false positive.
In this group of 6630 men,
15% of the men had a PSA level of greater than 4,
15% had a suspicious digital rectal examination,
and 26% had suspicious findings on either or both tests.
This is an astoundingly high number of men who had “suspicious findings.”
Then they did 1167 biopsies and detected cancer in 264 of these men.
Again, think about the 1167 biopsies.
Consider the pain and heartache, the confusion and stress.
These men had to contend with needles, knives and the surgery.
Then there’s coping with the recuperation.
Even a biopsy is never a simple procedure.
So they detected cancer into 264 of these men.
Of these, they removed the prostate in 160 men.
114 (71%) had organ confined cancer.
What this means is that the cancer was confined to just the prostate.
This is considered low-risk cancer since it’s unlikely to spread.
So these men really didn’t need to have their prostates removed it all.
No doubt, these men then experienced ED issues.
There’s the stress, heartache, and other problems to go along with erectile dysfunction.
And the problems may have been short or long term, maybe even permanent.
So what if these men hadn’t had their prostate removed?
What if they had just done what they used to call “watchful waiting”?
They call it “active surveillance” now.
But essentially, the patient and doctor really just keep a close eye on the cancer.
If it changes, they may act.
Otherwise, they might never have to do anything about the cancer.
And the patient continues to live his life.
So this study was designed to determine what happens if the cancer is left alone.
The researchers wanted to see how many prostate cancers metastasize (spread) if left alone.
The study took place over about 6 1/2 years.
They studied a group of men who they diagnosed with prostate cancer.
And then the researchers did the “active surveillance.”
They basically did nothing but have the patient come in for routine medical checkups.
They didn’t perform any additional biopsies for these men.
The average age of the participating men was 70 years old.
Of course, this is a prime time to get prostate cancer.
Out of 980 patients, just 31 developed cancer through metastasizing:
Metastases developed in bone in 18 patients, and in lymph nodes in 13,
So basically, 3% of men who are diagnosed with prostate cancer developed bigger issues.
That is to say that 3% of prostate cancers that are left alone will someday develop some type of metastases.
Only 3% of these men’s cancer may become life-threatening.
There is an even more striking way to put these numbers.
97 out of 100 men diagnosed with prostate cancer will not have any complications.
They won’t have metastases of the prostate cancer within six or seven years.
And perhaps a lot longer.
Now let’s go back to the first study.
Recall that almost all the cancerous prostates were self-contained, what they call local.
They hadn’t spread at all.
So now it is possible to do some really important arithmetic here that you want to pay close attention to.
Let’s assume you are in a group of 10,000 men who are screened for prostate cancer.
Let’s also assume that you elect to do nothing, no matter what the outcome of the screening.
4%, or 400 men, will be found to have prostate cancer.
But remember, you’re in the group that’s going to do nothing.
The odds of your NOT having a diagnosis of prostate cancer is of course 96%.
So now let’s say you have prostate cancer you are in that 4% or 400 men group.
What are the odds that your cancer will spread?
About 12 men will have more advanced prostate cancer within six or seven years. That’s just 12 men out of 10,000.
So by doing nothing, you are facing a little over one tenth of one percent chance of having serious prostate cancer.
Contrast that to the overtreatment of these men.
Out of 10,000 men, 1700 will have intrusive, painful and even debilitating biopsies.
And all to find 12 cancers.
You will miss all that as a “refuse to treat further” person.
Of course, it is possible that many men with prostate cancer will find that it spreads after six or seven years.
But the statistics say otherwise.
Very few men actually die of prostate cancer.
You’re much more likely to be dying to something else.
So why get your prostate cancer treated?
Why even get tested?
And that’s really where I’m at.
I don’t get treated — I don’t get tested… I don’t have to worry.
Yes there is a tiny, tiny chance that I’ll end up with prostate cancer.
But it’s a very tiny chance, less than 1/10 of 1%.
Whereas the chances of being overtreated, coping with biopsy and having unnecessary procedures are very high.
Prostate screening is full employment for physicians.
It may not be something you want to take part in.
The odds are vanishingly low that you will have deadly cancer.
And the odds are extremely high that you’ll spend untold amounts of money, time and heartache.
Citations
Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men.
http://www.ncbi.nlm.nih.gov/pubmed/7512659
Metastatic Prostate Cancer in Men Initially Treated with Active Surveillance
http://www.jurology.com/article/S0022-5347(15)05445-2/abstract
See this for more on Prostate Cancer, and see more on Men’s Health, and for more information see Cancer in Men.