Dear Fellow Travelers:
An article in the AARP Bulletin for November, 2012 entitled To Test or Not to Test by Chris Woolston is the basis for our conversation today. In that article Woolston cites an eye-opening statement made by the chief medical officer of the American Cancer Society, Otis Brawley, M.D. that deserves serious consideration. The statement is made in reference to the most frequently diagnosed type of cancer in the United States. According to the Cancer Progress Report for 2012 recently released by the American Association for Cancer Research this cancer will comprise about one-sixth of the 1.6 million new cases of cancer predicted to be diagnosed in 2012. The AACR figures places this cancer slightly ahead of breast and lung/bronchus diagnoses; with an incidence of almost 1/4 of a million cases, prostate cancer is at the top of the list.
The death rate from prostate cancer is less than breast cancer and is very small in comparison to lung/bronchus deaths; of the 28,000 estimated deaths due to prostate cancer a disproportionate number of the deaths are among African-American males.
The regular PSA (Prostate-Specific Antigen) test for all men between the ages of 50 to 70 or 75 is being challenged by many experts as “a highly flawed test that saves the lives while turning many men into cancer patients” according to Woolston, and Brawley adds “’no credible organization in the US actually recommends that men get screened for prostate cancer’ without a thorough discussion of the pros and cons [with their doctor]”.
The following statement comes from a fact sheet from the National Cancer Institute:
Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting tumors that are not life threatening is called “overdiagnosis,” and treating these tumors is called “overtreatment.” Overtreatment exposes men unnecessarily to the potential complications and harmful side effects of treatments for early prostate cancer, including surgery and radiation therapy. [source: http://www.cancer.gov/cancertopics/factsheet/Detection/PSA]
Prostate cancer is a real condition; it can be a very fatal cancer. And because of that fear, many men ignore symptoms and problems which could easily stem from other causes than cancer. Frequent urination, not being able to empty the bladder, trouble getting a stream started, pain or burning sensation, pain in lower back and hips and thighs, blood in the urine or semen, and erectile dysfunction are symptoms that should not be ignored; many times they are not an indication of cancer, but they should be discussed promptly with a physician.
As Powerful Patients each of us whether male or female should perhaps heed the cautionary implications of overdiagnosis and overtreatment that may be occurring for many men in the area of prostate cancer. The word “cancer” carries all kinds of sinister undertones and visualizations; for those diagnosed as well as the family and friends, the first response is often “I want it out!” That is a normal and very rational statement; in some cases the sooner a cancer is surgically removed the better. But with today’s improved medical technologies, perhaps it would be prudent to look at the situation from a long term, long survivorship point of view. Those are issues which can be considered more frequently each day as better ways of treating cancer are being found. In summation to his article Chris Woolston cites another comment by Dr. Brawley who, although he is a PSA skeptic, advocates a prostate-friendly lifestyle. That lifestyle is not only friendly to the prostate, it appears to be appropriate (and familiar) for almost every Powerful Patient; exercise 3 to 5 times a week, a diet with more fruits and vegetables, and appropriate weight with a BMI (body mass index) of about 25.
Warmest Wishes,
Mike
