Prostate cancer and the PSA test; why are they still screening and treating this “what if” disease?

A few years ago, doctors were being told that the PSA test for prostate cancer was highly inaccurate, especially in older men was usually unnecessary.  Treatment led to incontinence and sexual dysfunction when treated with radiation and surgery.  The worst part of this is that researchers have known for years that these tumors are usually slow-growing and are unlikely to be what is the cause of death in an older man.

Unfortunately, we have conditioned the public to make irrational decisions when we use the term cancer, leading some researchers to reclassify some growths which are not going to harm us and may simply be due to the aging process.

My dad is an example of what happens.  In his late 60’s, he was diagnosed with slow-growing cancer in his prostate and was treated with a hormone treatment that inhibits growth as well as radiation.   fifteen years later, he became incontinent and had to wear a diaper, which was horrible, since he was incontinent.    It was one of those oh by the way moments after they treated the “what if” disease and his doctors just followed protocols that they were all doing at the time.

Years later, we know better and about five years ago, we were told that we should be wary of not only the prostate PSA screenings in older males but also the treatments since the problem was not something that was going to harm us in most cases.   The following week, I personally heard more advertising for prostate treatments than I had ever heard.

Disease, disease, disease; do we need a better way of looking at things like this?

Recently, the NY Times discovered that way too many men are being told they need to have this screening, which is a life or death issue.    The data suggests that it is not, but we may be paying for treatments, based on the fear that has no actual benefit and is more likely to harm us than help us, especially as we age.

Check the article out here

Older Men Are Still Being Overtested for Prostate Cancer

Paula Span

A 79-year-old man came to see Dr. Jesse Sammon at the urology clinic at Henry Ford Hospital in Detroit the other day. The patient was referred by his primary care doctor because of a slightly abnormal reading on a screening test for prostate cancer.

“œIt happens weekly,” Dr. Sammon said, with frustration.

Eight years have passed since the United States Preventive Services Task Force recommended against routine use of PSA screening “” a blood test that measures prostate-specific antigen “” in men older than 75. In 2012, the task force recommended against all routine PSA testing, regardless of age.

Because most prostate cancer develops slowly, it doesn’t typically threaten survival or cause troubling symptoms for eight to 10 years. Even medical associations that disagree with some of the 2012 conclusions, like the American Urological Association, therefore discourage PSA testing for men with limited life expectancy.

Dr. Sammon”™s patient probably won”™t survive another decade, according to the standard tables used to predict life expectancy. Heart disease and diabetes ” he was taking 10 prescription drugs ” reduce his life expectancy further.

Read more.

On the other hand, the good news is that more men are choosing to avoid treatment and instead use surveillance.  You can read about that here

More Men With Early Prostate Cancer Are Choosing to Avoid Treatment

By GINA KOLATA MAY 24, 2016

Seemingly overnight, treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.

The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice.

In recent years, major research organizations have begun to recommend active surveillance, which for years had been promoted mostly by academic urologists in major medical centers, but not by urologists in private practice, who treat most men. In 2011, the National Institutes of Health held a consensus conference that concluded that it should be the preferred course for men with small and innocuous-looking tumors. Last year, the American Society of Clinical Oncology issued guidelines with the same advice.

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