Prostate cancer is riddled with indignities that cut to the core of manhood. It begins with a doctor's request to bend over for a digital rectal exam and can end in impotence and diapers. Very little in between is clear-cut.
Even being tested in the first place is controversial. The American Cancer Society and the American Urological Assn. recommend dual tests, a rectal exam and a prostate specific antigen, or PSA, blood test every year for men older than 50, and five to 10 years sooner for African Americans and men with a family history of the disease.
For The Record
Los Angeles Times Tuesday, August 04, 2009 Home Edition Main News Part A Page 4 National Desk 2 inches; 90 words Type of Material: Correction
Prostate cancer: In Health on July 3, 2006, an article incorrectly said that the American Cancer Society and the American Urological Assn. recommend a rectal exam and a prostate specific antigen, or PSA, blood test every year for men older than 50, and five to 10 years sooner for African Americans and men with a family history of the disease. In fact, the groups do not recommend routine annual screening; they say the tests should be discussed between patient and physician. The error was only recently brought to editors' attention.
For The Record
Los Angeles Times Monday, August 10, 2009 Home Edition Health Part E Page 5 Features Desk 2 inches; 90 words Type of Material: Correction
Prostate cancer: An article in the July 3, 2006, Health section incorrectly stated that the American Cancer Society and the American Urological Assn. recommend a rectal exam and a prostate specific antigen, or PSA, blood test every year for men older than 50, and five to 10 years sooner for African Americans and men with a family history of the disease. The groups do not recommend routine annual screening, instead saying that the tests should be discussed between patient and physician. The error was only recently brought to editors' attention.
But the American College of Physicians doesn't go beyond recommending counseling about possible risks and benefits of testing. And the U.S. Preventive Services Task Force found insufficient evidence to recommend either for or against routine screening.
"We don't know if having a PSA test helps men live longer or live better," says Dr. Timothy Wilt, professor of medicine at the Minneapolis VA Center for chronic disease outcomes research.
The line between lives saved by early detection and lives blighted by unnecessary treatment is still fuzzy. Testing often leads to treatment. And though standard treatments have high rates of cure, they also have mutilating side effects -- incontinence and impotence.
"If everyone over 50 were screened and biopsied, we might end up diagnosing up to a quarter of men," says Dr. Laurence Klotz, urology professor at the University of Toronto. In the United States, that would translate to almost 10 million men over the age of 50 being presented with a prostate cancer diagnosis. As it is, not every man is screened, but 234,460 men are expected to be diagnosed with prostate cancer this year; and an estimated 27,350 men will die of the disease.
Worse, PSA testing cannot always distinguish between a slow-growing cancer that is destined to be harmless and an aggressive cancer that could kill. At Johns Hopkins Medical Center, one pathology analysis of 300 surgically removed prostates found that 25% to 33% of the tumors were so small as to be clinically insignificant. Other studies have put the risk of over-treatment at anywhere from 16% to 56%.
"How many men can have their prostates sacrificed on that altar to save those 30,000 men? It's a very difficult question," says Mark Scholz, a Marina del Rey oncologist specializing in prostate cancer.
