The Myth of Early Detection

I wish I could have told my good friend and his wife that if his doctor believed in psa tests that he might have been harmed. Unfortunately, he had an aggressive type of prostate cancer and by the time it was detected it was to late. He barely made it to retirement and was unable to do all the things that his wife and he had planned. Isn't this yet another tool and would my friend still be alive if this tool was used to help detect the possibility of prostate cancer? I don't know but wish he at least had that option recommended to him. Wayne Wathen

I wish I could have told my good friend and his wife that if his doctor believed in psa tests that he might have been harmed. Unfortunately, he had an aggressive type of prostate cancer and by the time it was detected it was to late. He barely made it to retirement and was unable to do all the things that his wife and he had planned. Isn't this yet another tool and would my friend still be alive if this tool was used to help detect the possibility of prostate cancer? I don't know but wish he at least had that option recommended to him. Wayne Wathen

And by extension the pap test industry is bogus, and mammograms are bogus, and surgery is bogus, and treatment is bogus. Thanks.

Myrtie Webb

Prostate cancer is much akin to a turtle and a rabbit in an open box. The turtle, the indolent, nonaggressive cancer, wanders around the box, while the rabbit, the potentially aggressiveness cancer, hops around and might at any time jump out of the box. Thus, while we can diagnose prostate cancer, we cannot distinguish which cancer is the turtle and which is rabbit, and which needs treatment. More men die with prostate cancer than die because of prostate cancer.
PSA is a normal component of the prostate. It is not specific for cancer. Rather it is present in the normal, benign and cancerous prostate. The PSA test is therefore not the best tool we have for early diagnosis as some of the ???self-anointed??? experts continue to preach. The ability of the PSA test to identify men with prostate cancer is slightly better than that of flipping a coin. The fact that prostate cancer is an age-related disease, the PSA test merely precipitates a biopsy, wherein related to the age of the biopsied individual, and ?????? how hard it is looked for,??? i.e., the cancer (Welch. Journal of the National Cancer Institute, 97, 1132, 2005), he may or may not have cancer, in which case, if he has cancer, we cannot determine if it is a turtle or a rabbit!
The manufacturers of the PSA test sold the urological community on a test that cannot detect what it purports to detect, i.e., prostate cancer, and the media have conveyed to the average man that current treatments work. If the later is true, why do 25-35% of men with localized prostate cancer have a recurrence within 5 years? We have bought into the cultural myth that doing more is doing better! In the case of prostate cancer, doing less may be better, although men with a family history of prostate cancer or those with symptoms should be more aggressively monitored by their physicians.
By the way, I discovered PSA in 1970, and while in many cases, PSA is an indicator (???harbinger???) of recurrence of disease following treatment, it is not cancer-specific and cannot, in the manner in which the PSA test is currently used, be a screen for prostate cancer. If, however, one proceeds with serial determinations of PSA over a period of time, and thereby observes an increase from its initial level, possibly pointing to an underlying abnormality of the prostate, not necessarily cancer, PSA testing within this context has some merit.
For those with a further interest in the overdiagnosis and overtreatment of prostate cancer, please visit the website of the ???Cure Prostate Cancer Now Foundation??? at www.cpcnf.org.
Richard J. Ablin, Ph.D.
President, Robert Benjamin Ablin Foundation for Cancer Research (www.prostatefoundation.org)

First of all, thanks for your unflinching reporting. Of course there will be screaming. I hope that does not deter you.

One additional thought: Patients may scream the loudest, but doctors also drive the early detection machine. I am not speaking about calculating self-interest. It is frustrating--heartbreaking--to care for a patient and be unable to offer effective treatment. Most health care providers enter their work because of a need to do just that. To fail systematically is to face evidence of one's own mettle, even identity.

I'm not a physician; I'm a psychologist. I too have faced situations where my own impotence might prompt me to recommend a long-shot preventive measure or treatment in the hopes that this time it will be effective. But my wish does not make it so.

Tanya Shriver Castiglione, Ph.D.
Clinical Psychologist

Dangerous Myths

Many are ill-informed but few are dangerous. The myth of ???weapons of mass destruction??? recently lead America into a war that has cost thousands of lives. The ???Myth of Early Detection??? piece, by Sharon Begley in the April 6 issue of Newsweek, has the potential to cost Americans even more lives lost.

Ms. Begley starts her piece by stating that ??????the PSA test for prostate cancer does not decrease mortality from that disease??? and cites two recent studies. Unfortunately, I suspect she did not read the studies carefully, or perhaps, or perhaps she was ill-advised as to their conclusions.

The authors of the European study concluded that ???PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis???. The American-based study did in fact state that ??????the rate of death from prostate cancer was very low and did not differ significantly between the two study groups???. However, many men had PSA testing outside of the study. To take this into account, the authors performed additional analyses and concluded that?????? the cumulative death rate from prostate cancer at 10 years in the two groups combined was 25% lower in those who had undergone two or more PSA tests at baseline than in those who had not been tested.???

Taken together, Ms. Begley???s conclusions are distinct from those reached by the study authors. Destroying myths is often good work but in this case the myth that needs to be destroyed is the dangerous one promulgated by Ms. Begley.

The real problem in prostate cancer today is not PSA testing, it is deciding who needs treatment and who does not. More research is needed in this critical area. I will continue to advise my patients to have PSA testing, and if they are diagnosed with prostate cancer, to seek advice from experts who fully understand the heterogeneity of this disease before deciding that treatment is necessary.

Oliver Sartor, M.D.
Piltz Professor for Cancer Research
Director, Prostate Cancer Program
Departments of Medicine and Urology
Tulane University School of Medicine

Unintended consequences- If insurers/Medicaid/Medicare starts basing coverage for screenig on artilces like this, the poor will not have screening covered and the rich will pay for it themselves and the disparities in cancer mortality will increase.

Sharon Begley with her advanced BA degree (sic) has written an irresponsible article that might make many Americans think that cancer screening is futile. She goes on to further bash every type of cancer screening available. I do not pretend to be an expert on colon cancer screening but I know many who are experts. I will include a reference at the end of this comment that was published a little over 6 months ago by a taskforce of experts who have spent a lifetime researching colon cancer screening. I challenge( Professor )Sharon Begley to read this important reference.Her reference to stool occult blood testing is just plain ignorance. Stool occult blood testing is only one of many ways to do colon cancer screening. It is one of the least sensitive methods for preventing colon cancer. For every expert knows that to prevent colon cancer you have to identify premalignant (precancerous) growths called polyps. When polyps are removed then colon cancer is prevented. Identifying colon cancer does not prevent the cancer. The bottom line of the US Multit-Society Task Force is "is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening." Sharon you may find the reference in GASTROENTEROLOGY 2008;134:1570???1595.

My seventeen year old son, Paul, died of lymphoma after a ten month battle to live. In the beginning when his lung collapsed and he was being treated at Denver's Childrens Hospital I kept asking about the chances for cancer. The doctors kept saying: "Paul isn't a cancer candidate because he's a superb specimen, and his blood's too good." When he underwent surgery to removed the "adnoma they thought he had and also his lung" the surgeon discovered a massive tumor, a lymphoma, which had grown around his lung and strangled it. So he was under the care of an oncologist who said he needed to use a "sledge hammer approach to treatment because he had B cell Lymphoma which was very aggresive." After Paul's death I asked the oncologist if he could have been saved if the cancer had been discovered earlier. His reply in 1981 was this: "No because the biology of the cell was set from the start to be very aggresive. We had to try though." Now 28 years later the same conclusion is there that it's the biology of the cell which determines the outcome. Susan

I didn't mean to leave two comments that are substantially the same.
Please take my mistake as a kind of Hear! Hear!

Please keep your teeth sunk into the backside of this story and don't let go when they pressure to do so mounts.
It is a very important topic as, alas, the lack of comments probably proves.
Thanks.

This is an important article. The fact that there are no comments is probably, alas, proof.
Please keep your teeth sunk into this story and don't let go. We can't afford to forget about it.
Thanks.