Volume 4, Issue 50
December 15, 2011
Got prostate cancer?
Avoid your oncologist
So you had your recent annual PSA test for prostate cancer and it came up positive. Naturally, you’re worried. But should you be more worried about the high PSA or the treatment for it?
I had a patient in this very situation recently. His PSA has always been around 1.6 ng/ml. But this last time it jumped to 2.4 ng/ml. His doctor immediately referred him to a urologist for a biopsy. He asked me if he should go. I said, “Absolutely not!”
And just this past week, the United States Preventive Services Task Force (USPSTF) agreed with my advice.
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Here’s why: Almost 90% of men with prostate cancer found from annual PSA testing go on to receive treatment right away. The standard treatment options include radiation therapy, surgery, or hormone blockade therapy. So how successful are these therapies?
Both of the two largest trials that looked at this question said the success rate with each of these approaches is negligible. That’s right! They don’t work at all!
One trial conducted in Europe looked at men between the ages of 50 and 74 treated with any of these therapies. It found that the therapies reduced the death rate by only 0.06%. This is a statistically insignificant reduction.
A similar trial in the United States actually found a 0.03% increase in the death rate in men receiving these therapies. Like the other study, this increase was not statistically significant either. So the bottom line is that statistically, these therapies in no way extend life beyond doing nothing. But even if they don’t work, at least they are free of any significant side effects, right? Not exactly.
Take surgery, for example. Out of every 1,000 men who have their prostates removed about five of them will die within one month. Somewhere around 100 of them will have life-threatening blood clots. (That’s one out of ten!) Around 50 will end up completely incontinent. Between 300-500 will be impotent. And as many as 70 will have serious complications, such as bleeding.
Patients who have radiation therapy also have a serious risk of side effects, especially subsequent erectile dysfunction and/or urinary incontinence. Several studies have placed this risk at between 20-30%. Radiation therapy also can cause potentially serious radiation burns to the intestines. This often results in permanent intestinal disorders.
Even though it’s not an FDA-approved indication, many doctors will use hormonal blockage injections and/or pills. The problem with this approach is that 40% of the men will become impotent. Others will develop osteoporosis, weakness, fatigue, hot flashes, sleep disturbances, fat gain, and breast enlargement. There also is evidence that this therapy increases the risk of heart attacks, bone fractures, and diabetes. Here’s how the USPSTF panel sums it all up.
“Although about 90% of men are currently treated for PSA-detected prostate cancer in the United States – usually with surgery or radiotherapy – the vast majority of men who are treated do not have prostate cancer death prevented or lives extended from that treatment, but are subjected to significant harms.”
When I was in medical school in the 1960s, they taught that the first order of the day for any doctor in any situation was to be sure to do no harm to the patient. So that’s why I told my patient to avoid getting a consultation from a conventional urologist. I think it’s obvious from above that there is nothing to gain from what they have to offer in men with abnormal PSAs who don’t have any symptoms. And there certainly is plenty of potential harm. Next week, I’ll tell you what I advised him to do instead.
Finding your Real Cures,
Frank Shallenberger, MD
Why Federal Panel Recommends Against PSA-Based Screening For Prostate Cancer by Christian Nordqvist, 10 Oct 2011. http://www.medicalnewstoday.com/articles/235738.php
Chou R, Croswell JM, Dana T, Bougatsos C, Blazina I, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Oct 7.
Lin K, Croswell JM, Koenig H, Lam C, Maltz A. Prostate-Specific Antigen-Based Screening for Prostate Cancer: An Evidence Update for the U.S.
Preventive Services Task Force. Evidence Synthesis No. 90. AHRQ Publication No. 12-05160-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2011.
Copyright 2011 Soundview Publishing, LLC.
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