Another negative prostate cancer study but maybe something useful

As we've discussed with many of you personally, prostate cancer is the currently the most challenging and controversial area in men's health.  Screening has not been shown beneficial and is no longer generally recommended by the USPSTF (a committee established by the US Public Health Service to provide care recommendations).  

But many patients are uncomfortable NOT screening for a very common disease (about two thirds of men will eventually develop prostate cancer). 

On top of all of this, even when we find a prostate cancer, the treatment is sometimes worse than the disease.  Prostate surgery often causes erectile dysfunction and occasionally even incontinence. 

A recent study published in the New England Journal of Medicine followed 740 men diagnosed with prostate cancer who were randomly assigned to either surgery or no treatment and then were followed for ten years.  

There was no difference in total mortality (about half of each group) and no difference in mortality specifically related to the prostate cancer (6 - 8% in each group).  There were fewer cases of cancer spreading to bone in the surgery group.

So, should we not treat?   The evidence to support simply observing patients diagnosed with prostate cancer continues to grow and this study adds to that.

There was one other interesting finding.  When the outcomes were segregated by how high the PSA value was, there appeared to be a difference in the treatment options.    For men with PSA > 10 (the upper limit of the normal range is generally 4.0), there was a small decrease in the risk of death in the surgery group. 

What does all this mean?   

We think that the decision about whether to screen for prostate cancer should be made by each individual patient after discussing theses issues with their physician.  Particularly in an area lacking definitive answers and with such complex and potentially confusing data, we believe that there is no reasonable "one size fits all."

If you're not a member of our practice, be sure to ask your physician about prostate cancer screening.  There's a lot to discuss.

Stay well!

N Engl J Med 2012; 367:203-213
Posted by: Scott W. Yates, MD, MBA, MS, FACP

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