In fight against prostate cancer, knowledge is key

Many men know that prostate cancer is a leading cause deaths among American men, killing more than 28,000 last year. Awareness only grows when public figures such as personal-finance guru Clark Howard and R&B singer Charlie Wilson step forward to discuss their own cancer battles, and to urge men to be screened for the disease.

But, perhaps surprisingly, many of the nation’s leading cancer researchers do not recommend routine screening of men with only an average risk for the disease. Screening can detect cancer, but the resulting treatment — surgery, chemotherapy and radiation therapies — may not actually decrease deaths, they say.

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X-ray slides of prostate cancer

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Dr. Otis Brawley says men should be ‘proactive about their health’ in a rational way.

MORE ABOUT PROSTATE CANCER:

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• PHOTOS: High-profile men and prostate cancer
• VIDEO: High-profile men and prostate cancer
• Combo treatment for prostate cancer cuts deaths
• Vitamin C or E pills do not prevent cancer, study notes
• Rodney Ho's blog about Clark Howard
• ABC report on prostate cancer

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Unlike colon, breast and cervical cancer, routine screening for prostate cancer has not yet proved to save lives, and resulting medical intervention may be unwarranted, says Otis Brawley, chief medical officer at the American Cancer Society’s national headquarters in Atlanta.

A man should arm himself with enough facts to weigh his options and make an informed decision with his doctor based on his age, health and other factors, he says.

“I’m not against a man getting screened, and I am not against a man getting treated,” said Brawley, an expert in the field of prostate health. “I’m just against a man … not knowing how complicated this issue is.”

The American Cancer Society recommends that doctors discuss the benefits and limitations of screening and allow patients to make their own decisions. The American College of Physicians and American Academy of Family Physicians also recommend against routine screening, and the American Urology Association follows ACS guidelines.

Here is some information Brawley says men should know to help make an informed decision:

• Screening: The blood test for prostate cancer was approved by the Food and Drug Administration for early detection only, such as when a patient has a strong family history or exhibits symptoms. Routine screening “is testing of [any] patient who is over the age of 50, as opposed to a man who has some symptoms,” says Brawley. The cancer society recommends against mass screenings such as those offered at grocery stores or health fairs because a man can’t talk to his physician about his individual situation, he says.

• Limitations: ACS data indicates that at least 40 percent of men diagnosed with localized prostate cancer will survive without treatment, and another group, even when aggressively treated, will ultimately die, says Brawley. “The problem is that we have spent a lot of money and resources to discover cancer, but we have not worked to find the test that allows us to determine the cancer that will kill rather than the one that we can ignore. We would like to be able to tell someone that it’s going to stay in your body and not need treating, but we don’t have that test yet,” he says.

• The risks: Treatments for prostate cancer — including radical prostectomy, radiation, estrogen or hormonal therapy — all have side effects. Radiation can cause burning and sores of the rectum and skin. More than half the men who undergo radical surgery complain of some sexual dysfunction and about 30 percent complain of urinary dysfunction (incontinence). Studies indicate that more than 300 men die every year from prostate cancer treatment.

• Claims vs. reality: In 1991, the National Cancer Institute began a study of 73,000 men to see if prostate screening saves lives, but thus far no significant distinction between the death rate of the screened and unscreened groups has been found. The claim that early diagnosis and treatment leads to a 90 percent cure rate is correct, Brawley says, but it doesn’t note that many or most among that 90 percent also would have done quite well without treatment. U.S. mortality rates from prostate cancer have gone down 37 percent from 1993 to 2005, but the decline in mortality in nonscreening countries like Britain has been similar. Using the increased survival figures as evidence of screening’s benefit is fallacious, Brawley says.

• Proactive measures: “We want people to be proactive about their health but in a rational rather than an irrational way,” Brawley says. “For instance, we know that colon cancer screening decreases your risk of death by 25 percent, but in many areas, only 25 percent of men get colon cancer screening. But in those same areas, about 80 percent of men have been screened for prostate cancer, which we [only] hope is beneficial. That’s irrational to me.”

PROSTATE CANCER FACTS

• Incidence: Sixty-four percent of prostate cancer is diagnosed in men 65 and older. African American, Jamaican and men of African descent have the highest incidence rates in the world.

• Death rates: Prostate cancer is a leading cause of cancer deaths among American men, with an estimated 28,660 deaths in 2008. Death rates have decreased for all men and among African American men since the early 1990s, but still remain twice as high as those of white men.

• Signs and symptoms: Very early prostate cancer usually carries no symptoms, but men with the disease may experience weak or interrupted urine flow, inability, difficulty or frequent urinating. Blood in the urine or pain or burning while urinating are also symptoms that should be evaluated.

• Risk factors: Age, ethnicity and family history remain the only established risk factors for prostate cancer.

• Survival: More than 90 percent of prostate cancers are discovered in the local and regional stages, with five-year survival rates approaching 100 percent.

Source: American Cancer Society