By Jane Farrell
Prostate cancer is a frightening disease for men and the women who love them. So doesn’t it seem indisputable that men should undergo the Protein Specific Antigen (PSA) screening test for this illness? Two studies that have just been published give very different answers.
Researchers at the University of Rochester Medical Center, in Rochester, NY, came down heavily in favor of PSA testing: They said this week that their findings indicate the early testing and subsequent treatment for the disease may prevent up to 17,000 metastatic cases of prostate cancer per year.
On the other hand, a study earlier this month from the Harvard School of Public Health found that lifestyle changes – quitting smoking, exercising, losing weight, eating well – are likelier than treatment to prolong life in men who have been diagnosed with non-metastatic prostate cancer.
The University of Rochester study was published in the journal “Cancer,” while the Harvard School of Public Health study appeared in the “Journal of the National Cancer Institute.”
Whatever the researchers’ conclusions, the basic statistics aren’t in dispute: According to the American Cancer Society, about 241,000 cases of prostate cancer will be diagnosed this year in the U.S., and 28,170 will be fatal.
But while those numbers are frightening, experts also say that in many cases, prostate cancer is a slow-growing illness and doesn’t necessarily merit the usual treatments of surgery and radiation therapy (except in cases where the cancer has spread). If the slow-growing, localized cancers were left alone, the experts say, men would not have to undergo the treatments that often leave them incontinent and with erectile dysfunction.
In presenting his researchers’ findings at the University of Rochester, study co-author Edward M. Messing, M.D., acknowledged the negative effects of possibly unnecessary treatment after early diagnosis. “Yes, there are trade-offs associated with the PSA test and many factors influence the disease outcome,” he said. But that shouldn’t deter men from taking the test, he added. “Our data are very clear: not doing the PSA test [early] will result in many men presenting with far more advanced prostate cancer. And almost all men with metastasis at diagnosis will die from prostate cancer.”
The argument about PSA testing has been ongoing: Last year, the U.S. Preventive Service Task Force, an independent agency of health-care experts, recommended against early screening, saying men would have their lives disrupted by unnecessary treatment. (This isn’t the first time the task force has made a controversial recommendation. In 2009, it recommended that women have mammograms every two years beginning at age 50. The American Cancer Society recommends annual mammograms beginning at age 40.)
Using the U.S. Surveillance, Epidemiology, and End Results (SEER) database, Messing’s study examined the number cases of prostate cancer between 1983-1985 (pre-PSA testing), with the number of cases in 2006-2008 (when PSA testing was encouraged). Messing said that over the past 20 years, prostate-cancer deaths have been reduced by 40 percent without substantial changes in the usual treatment of surgery and radiation therapy. The implication: widespread PSA testing is a lifesaver.
On the other hand, the Harvard School of Public Health survey found that men with prostate cancer are likelier to die from other diseases that could be prevented and not from the prostate illness itself.
Mara Epstein, lead researcher at the Harvard School of Public Health, said that physicians and patients should focus on potentially lifesaving behavioral factors--quitting smoking, exercising more and eating better-- rather than on a test to detect what’s usually a slow-growing disease.
In a statement, Epstein said, “We hope this study will encourage physicians to use a prostate cancer diagnosis as a teachable moment to encourage a healthier lifestyle, which could improve the overall health of men with prostate cancer, increasing both the duration and quality of their life."
Added senior author Hans-Olov Adami, professor of epidemiology at HSPH,. “Our study shows that lifestyle changes such as losing weight, increasing physical activity, and quitting smoking, may indeed have a greater impact on patients’ survival than the treatment they receive for their prostate cancer.”
In studying statistics of American and Swedish men who had been diagnosed with prostate cancer, the Harvard researchers said that ultimately 11 percent of American men who were surveyed died from prostate cancer specifically, while the figure was 29 percent for Swedish men. Most of the deaths that were specifically related to prostate cancer occurred among older men and men diagnosed before the existence of PSA testing.
To test or not to test: It can be a tough choice. A good way to start the decision process is to help your loved one write down the risks and benefits of both options, and encourage him to talk to his doctor.