Upfront
The case for early detection and effective treatment for prostate cancer: 3 The Myths and Facts of Prostate Cancer
by
Ralph Valle

Location of prostate (click to see full size)

With medical opinion divided and many myths propagated about the disease, it is hard to overcome the apathy of males toward discovering the real facts about prostate cancer.

Let's look at some of the misinformation spread about prostate cancer.

1. Prostate cancer is an old man's disease.

True, the risk and incidence of prostate cancer increase with age, but a full 25% of prostate cancers are found in men below the age of 65(1). Now, that represents around 40 to 50 thousand men every year diagnosed in their working years, the prime of life.

Life expectancy in men is going up. At the beginning of the twentieth century male life expectancy was 57 years. At the end of the century it was 72 years. We added an extra 26% to the life span in one century alone. For most of written history, life expectancy was about 35 years, but technological advances and hygiene have had a tremendous impact.

Old age is now a moving threshold. As the population's general health improves and men avoid death from other causes, the risk of prostate cancer becomes more significant and awareness about such risk needs to be intensified.

2. Most men die with prostate cancer rather than from prostate cancer.

This statement is a piece of misinformation in itself. Why? Because it ignores the fact that the prostate cancer that kills men is not the type of cancer commonly found at autopsy of men who die of other causes without ever showing any sign or symptom of prostate cancer.(8, 9). The type of cancer found merely at autopsy IS NOT histologically or in size comparable to the clinically significant cancer that progresses - and does so at a rate that causes death. All too conveniently, critics ignore this simple fact and use the prevalence of cancerous prostate cells to misinform and confuse the public.

3. PSA is a non-specific marker -- and getting a raised number on a PSA test causes stress in men who turn out not to have prostate cancer.

True to the extent that PSA is not a prostate cancer-specific test -- that is, it may go up if anything is wrong in the prostate, such as a passing infection or BPH. So those other possible causes of PSA rise have to be excluded before cancer is diagnosed.

On the other hand, PSA is the best cancer marker science has ever developed to detect cancer, any cancer!

PSA is able to detect prostate cancer 7 to 9 years BEFORE it becomes clinically significant (16). PSA derivatives such as free-PSA have made it easier to tell the difference between prostate enlargement and prostate cancer. One study has demonstrated that in a small population sample, free-PSA was able to recognize aggressive prostate cancer 10 years before diagnosis. (17) This provides men with a CHOICE that without this test they would not have.

The misinformation about this test is phenomenal and it is politically- and cost-driven at the expense of John Q. Public. Any stress generated by this test is pale compared to the stress of an advanced prostate cancer diagnosis (11), but this is totally ignored by the critics. After all, those same experts proclaim PCa an old man's disease and then recommend doing nothing for men older than 75, which is the age range with the highest mortality rate prevalence.

4. Prostate cancer treatments do more harm than good.

This claim refers to well-known side effects of treatment. There is no denying, prostate cancer treatment can result in impotence and/or incontinence. The numbers of patients who experience side effects can be high, depending on treatment choice and quality of care and on other factors such as the man's general health before treatment.

But to say, treatment does more harm than good ignores what happens to those men whose cancer is not discovered at a curable stage.

Prostate cancer is a progressive disease. Untreated, it can cause far worse than urinary dribbling or incontinence -- it causes urinary flow problems, ureteric obstructions, urinary retention, kidney failure, bowel obstruction, chronic edema with risk of death from infection, bone metastasis, compression fractures and, yes, impotence and incontinence(11).

So it is pay now or pay later. The anti-screening "experts" totally ignore this. They hold out a deceptive promise: you can avoid side effects from treatments and keep your "good life" -- but the "good life" is painted as though it were life without progressive, incurable cancer.

European studies(13) have exposed the high mortality of untreated prostate cancer. There is a marked difference in mortality when clinically significant prostate cancer goes untreated. Medical authorities in the USA have consistently ignored such studies even though the evidence of the natural history of prostate cancer is well documented.

5. Early detection and treatments have not been proven to improve survival.

This statement is based not on any positive evidence against early detection but on the lack of randomized, controlled trials. Trials are ongoing in Europe and America. Unfortunately these trials will not mature until 2005 to 2010. In the meantime, we do have results from a randomized, controlled trial done in Quebec, Canada(3) . These results have gone largely ignored and criticized by the anti-screening "experts."

The Quebec trial demonstrated a 69% benefit in survival by early detection using PSA and DRE testing with effective followup treatment. Yes, and to put the results this way -- 67% fewer deaths among men who were followed with regular PSA tests. In the USA alone this could result in 26,000 fewer deaths a year.

These are very significant numbers. Another piece of evidence comes from the U.S: in Olmsted County, Minnesota(12) early intervention by testing with PSA and DRE has been associated with a reduction in the mortality rate.

In population-based studies(4), treatment of prostate cancer by surgery has demonstrated a 10-year survival benefit as compared to doing nothing but watch and wait. The survival benefit is much higher in aggressive disease than it is in lower disease grades, in which the 10-year survival is almost equal for both. Most men with low grade disease who are surgically treated do not have to contend with disease progression at 10 years. Men who have low-grade disease but are not treated, just watched over, are more likely to contend with disease progression and to have a higher disease-specific mortality.

Ample evidence exists to show that testing with both PSA and DRE has directly reduced the prostate cancer mortality rate. The sooner this is recognized and supported by medical opinion, the more deaths will be prevented. Survivors need to become more proactive and promote awareness. We owe it to our families and to ourselves!

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