- Wednesday, April 06, 2016
Don't wait to check for signs of prostate cancer.
By Dr. Mark DeGuenther
When I began my urologic training 25 years ago, more than 75 percent of patients newly diagnosed with prostate cancer had incurable cases because the disease already had spread to other parts of their body. Five years ago, such cases were down to less than 10 percent. Unfortunately, we are starting to see the number of patients presenting with metastatic prostate cancer (cancer that has spread beyond the prostate) rise again. We can attribute this growth to the discouragement of the prostate-specific antigen (PSA) test by the U.S. Preventive Services Task Force (USPSTF) in 2012.
The death rate from prostate cancer has fallen by approximately 40 percent since prostate cancer screening went into widespread use in the mid-1990's.
Current treatments for prostate cancer have less complications, mobility issues and side effects, but are not significantly more effective, so the decline in death rate is only attributable to earlier detection.
It is commonly understood that with any sickness, whether it is cancer or an infection, the sooner you can detect it and start treatment, the better the results towards a cure. Prostate cancer is no different.
It is often said that prostate cancer is a disease that you will die with, but not die from. However, prostate cancer is the second leading cause of cancer death in America. It is certainly true that many men will die with their prostate cancer, but there are also many men whose lives are cut short because of the disease. It is younger men (those under 70 years old) who need to be screened to detect prostate cancer.
The government recommendation not to screen was based on studies too short in duration to determine the true death rate from prostate cancer. Meanwhile, follow-up studies on the same groups of patients have shown that there is a definite decrease in the death rate similar to what epidemiological data (patterns, causes and effects of disease on health) says: it matches the decline in death rate we see in the general population. Screening to find prostate cancer prior to its spreading saves lives.
The recommendation to not proactively PSA test, in my opinion, is rooted in the quest for short term budget savings. Physicians in Sweden stopped screening for and treating prostate cancer over 30 years ago. Ten to 15 years later, they found the cost to society, in economic terms, became much greater. This is largely because patients had developed metastatic disease and treating metastatic disease is significantly more expensive. Moreover, if these patients had been diagnosed and treated earlier, most could have easily been cured. There is clearly a "human cost" as many died prematurely. Sweden now has the one of most aggressive screening in the world, not just for humanistic reasons, but also for economic benefit.
In the short term, not performing PSA screening eliminates annual testing and saves money, but in the long term, more money is lost. For example, you can defer maintenance on your car or house and save money in the short term, but eventually you are going to pay more because of magnitude of the problems that arise from deferred maintenance.
This issue is so prominent and recognized by not only the medical community, but the general public as well. Last year, the Centers for Medicare & Medicaid Services (CMS) proposed that physicians be financially penalized if they order screening PSA tests on too many patients. Due to overwhelming public protests, CMS has withdrawn this proposal. Because of this, patients and their physicians are still free to decide what is best for their health.
Despite any recommendations, there are men who do not want to be screened or diagnosed because they have heard such terrible things about the side effects of the traditional treatments, such as incontinence and impotence. These men should take comfort in the truth that the side effects are not as common or devastating as people may think.
Prostate cancer kills. Prostate cancer caught early is incredibly curable. The only way to catch it early is through screening because there are no symptoms of prostate cancer until it is very advanced.
This article was featured on AL.com-