April 22, 2013 · 8:53 pm
Since I actually grew a scraggly mustache and some of you contributed, I am dedicating this post to Movemeber. They just released a video you can watch here. I think the positive message is terrific, although I personally do not believe we will “put prostate cancer out of business” as Jonathan says. My reality is that cancer is a disease of aging and will always be with us. Prostate cancer is no exception. If we age, we accumulate DNA damage, although some studies suggest it is more the cellular response to DNA damage than the DNA damage itself that does us in. Our telomeres shorten, and our ability to whack the bad cells in us slowly gets weaker. 100 years ago, very few men lived long enough to get prostate cancer. Now, most men in developed countries will probably live long enough to do so as you can see from this table.
So, our goal is to leave the unimportant prostate cancers alone, and keep men who have the more aggressive ones alive and in good health for as long as possible. We have lots of new and developing tools to help us with this, and for the most part, I think prostate cancer is already a “chronic illness”, even though some of us, sure enough, will die from it. Fortunately, even now, that is only about 3/100 men. So keep exercising, don’t smoke, eat the right things, and die of something else if at all possible, and as late as your genes will let you.
November 3, 2012 · 8:40 am
When you go through the screening systems at our national airports, there are often videos that describe the process, reminding you to take any liquids out of your suitcase and so forth. I think it is time for cancer centers (and others) to do the same thing at their annual screening events for breast, prostate and other cancers. I have no problem with participating in screening events if the participants are fully informed about the benefits, risks, and the controversies surrounding screening for prostate cancer. However without such information, I fear that most men simply open Pandora’s box without really knowing what they are getting into. Does a 75 year old man realize that his chances of dying from prostate cancer are tiny compared to the other lurking causes of death? Does a 60 year old man understand that a Gleason 6 cancer can be followed safely with active surveillance, but that it will require “life long” repetitive biopsies? The NEJM article on this issue this week is worth everyone reading. Marketing should not be what medicine is about.
October 7, 2011 · 11:15 pm
Yesterday the US Preventive Services Task Force released information that it will recommend against routine PSA testing for prostate cancer. Predictably, there has been a firestorm of responses, mostly criticizing this finding. The most vocal critics are prostate cancer patients and advocates, including their physicians. As a physician who has cared for several thousand prostate cancer patients and a member of this community, I think it is appropriate to chime in. However, what I am about to say will not set well with many. Here is an inconvenient truth: If you live long enough, you will probably develop prostate cancer. 55% of men in their 50’s and 64% of men in their 70’s have prostate cancer when their prostates are carefully examined at autopsy. And the frequency goes up from there. These men are the silent majority – the ones who had no treatment, remained continent and potent in many cases, did not have the anxiety of knowing they had cancer, and lived a full life, dying from some other cause. In fact, prostate cancer accounts for only 4% of all deaths in men. The patients who have been diagnosed and successfully treated ALL feel that prostate cancer screening saved their lives. Most of us who treat prostate cancer or participate in screening for it would like to believe the same thing. Indeed there are some retrospective studies like the famed Tyrol, Austria study that would make us believe that prostate cancer screening is having a major effect. And yet, as I previously blogged on screening, randomized trials suggest that if we save lives at all, …1) It is only in men under 65 and 2) you have to screen and treat a very large number of men (with all those side effects), to save even one life. This controversy will not go away soon, and we all await the day when molecular testing can tell us which cancers we can safely ignore, even if we find them “by accident” on screening. Until then, I think it is perfectly reasonable to salute all of our men who have lived into their 70’s and 80’s, especially those 50% walking about who have prostate cancer and don’t know it and will never miss nor be harmed by NOT being treated or screened. They are the silent majority in this debate.