A recent study out of Europe found that, over an 11 year period, men who were screened regularly for prostate cancer using the PSA test were less likely to die of prostate cancer than those who were not. Here is a link to an abstract of the study which has been published in the New England Journal of Medicine. http://www.nejm.org/doi/full/10.1056/NEJMoa1113135 While this may sound impressive at first reading, there are lots of cautions associated with the news.
In the first place, a similar study conducted in this country found no improvement in prostate cancer survival for men who had regular PSA tests.
Second, the effect found by the European study was small. To save one life, 1055 men had to be screened. On average, 35 of these men were found to have prostate cancer. Each of them underwent treatment. The effects of prostate cancer treatment are often quite debilitating. Please take a look at my blog post of last September in which I discuss the depressing statistics about the effects of the various forms of treatment on sexual function and other important issues. This means that to save one life, about half of the men who get treated will have bad effects from the treatment with no health benefit for them at all.
Even if the European study is considered to be reliable and the contrary American study is disregarded, the question of whether to have a regular PSA test and what to do if the finding turns up positive remains a difficult one to answer. We know that most prostate cancers are slow growing and will probably not kill us before something else does. Unfortunately, we also know that we cannot distinguish at the time of diagnosis between the slow growing prostate cancers, which probably won’t kill us, and the aggressive, fast growing prostate cancers, which will probably kill us if not themselves treated aggressively. We also know that our ability to successfully treat the aggressive form of prostate cancer is still quite limited. You may get all the best and most aggressive treatment and still die from the cancer.
If you get tested regularly and live long enough, you are almost certain to get a prostate cancer diagnosis at some point. The important thing is to think about the question of what to do and try to make an informed decision rather than reacting in a knee-jerk fashion to the news that there are some cancer cells in your prostate. All the statistics, including this European study, suggest that many, many men get debilitating and unneccessary treatment for prostate cancer that doesn’t improve their survival chances. You have to make the choice; make it a good one based on information and not irrational fear.
