Wednesday, October 12, 2011

What's New in Prostate Cancer

The accepted wisdom for men is that if we live longer enough, we'll all get prostate cancer at some point. There were two stories in the media this week about the second-most common cancer among men in the U.S.

Most people have been talking about the new suggestion that healthy men do not need to get prostate exams, as decided by the U.S. Preventive Service Task Force.

NPR looked at this issue on Talk of the Nation:

Prostate Cancer Screenings Not Recommended

 October 12, 2011
 
The U.S. Preventive Service Task Force recommended against screening for most healthy men, concluding that it causes too much anxiety and leads to unnecessarily aggressive treatment including surgery. Many doctors and patients say they will continue the prostate specific antigen (PSA) blood test.

NEAL CONAN, host: Last week, we talked about life after prostate cancer surgery, but since then, prostate cancer's been all over the front page. Late last week, word leaked that the U.S. Preventive Service Task Force would no longer recommend routine screening. This week, the studies to support that conclusion came out, along with op-eds that challenged it. If the new screening recommendation has you scratching your head, give us a call: 800-989-8255. Email: talk@npr.org. You can also join the conversation on our website. Go to npr.org and click on TALK OF THE NATION.

Joining us again to talk about prostate cancer and the recent recommendation is Tara Parker-Pope, editor of The New York Times Well blog. And nice to have you back on TALK OF THE NATION.

TARA PARKER-POPE: Sure. Happy to be here.

CONAN: And as I understand it, the fundamental finding of the task force is that most of the time, prostate cancer grows so slowly, that most men will never know it's there. But if they do find out they have cancer, it is very, very difficult not to do anything about it.

PARKER-POPE: That's exactly right. I've interviewed several men who say that, you know, the moment your doctor looks you in the eye and says you have prostate cancer, you know, you can't really get that thought out of your head. And your sort of fast reaction is, well, we've got to get it out. And what we know is that, often, you probably don't have to get it out. But it's not really about what's happening at that individual patient level. What we're seeing is that when you think about the risk and benefits of a screening program, you have to look at large populations.

You need to see: Are we making a difference? We're finding cancer early, but are we saving lives? And the resounding conclusion I know from several studies is that no, we really probably are not saving lives. If we are, it's so few lives, it's dwarfed by just the enormous pain and suffering we're causing men by testing - by doing this screening test.

CONAN: Enormous pain and suffering, because they then go have procedures of various types, and men end up impotent, incontinent or both.

PARKER-POPE: Right. And it's really from - it's the stress of being told you might have cancer from having a high PSA rating. Men go in and get these biopsies, which are not inconsequential. They can be uncomfortable, and they can actually lead - I've actually heard from several readers where, you know, men have ended up in the hospital with infections from a biopsy. That is a rare complication, but it does happen. And once you get the biopsy, if it's clear and you've still got the high PSA, your doctor's going to say, well, I'm not confident. Come back again. Come back again for repeat biopsies.
And if you do find cancer, you know, a biopsy's 12 or 15 sort of quick samples from the prostate. And if you find cancer in even one of those cores, then you're suddenly in this world of, you know, do I make a decision to undergo treatment, which might leave me incontinent - will probably leave me incontinent and impotent, at least for a little while.

CONAN: And among the controversies here is the fact that the board reached this conclusion two years ago, and because of their experience with the uproar after making similar recommendations on breast screening, breast cancer screening, they waited two years till they could assemble the science. In the meantime, tens of thousands of men may have had procedures they didn't need.

PARKER-POPE: Yeah. And I guess - I mean, I think it is probably prudent to, you know, get the science right, and that's what the chairman of the task force has said. Should we have had this debate two years ago? Maybe. But would people have heard it in the midst of the mammography recommendations? You know, I don't know that we can second-guessed that decision, because the truth is the recommendation is out now, and plenty of men are still going to continue to get PSA screening because they find it very difficult, as do their doctors, to give up this idea that they really truly believe earlier is better. Find cancer early, it's better. It's a really difficult concept to grasp that that's not always the case.

CONAN: And we've seen all kinds of people come out in the past couple of days and say, wait a minute. This is a test that saves lives. Who are you kidding? Why are we stopping this?

PARKER-POPE: Yeah. And it's interesting - I mean, there is a legitimate debate here about what these large studies have shown. The U.S. study pretty clearly showed it did not save lives, but you can, you know, poke holes in that study for sure. The European study, not quite as clear. There was a lot of variations and a lot of problems with the data in that study, as well, that showed that maybe one in 50 men is helped. And the argument is quickly - well, if at least one life is saved, then shouldn't we do it? But you really have to kind of calculate the suffering that is caused over large groups to, you know, to make that decision. You know, one in 50, is that a reasonable trade off for, you know, as Otis Brawley at the American Cancer Society said, the PSA test is 50 times more likely to ruin your life than it is to save your life.
Read the whole transcript.

The other story that hit the media this week was that taking vitamin E increases the risk of having prostate cancer. There had been previous evidence that vitamin E might help prevent or lower the risk of prostate cancer, so this will generate some fear in men (like me) who have been taking 400 iu of vitamin E each day for several years.

Vitamin E Increases Prostate Cancer Risk, New Study Shows

by Catherine Pearson (Huffington Post)

Prostate Cancer Vitamin E

First Posted: 10/11/11

Taking vitamin E supplements may harm men's health, according to a new study that suggests the supplements can significantly increase the risk of prostate cancer.

The findings come from the large Selenium and Vitamin E Cancer Prevention Trial, otherwise known as the SELECT study, the initial results of which were published in 2008. Designed to test evidence indicating that selenium (a trace mineral found primarily in plants as well as some meats and seafood) and vitamin E (an antioxidant found in vegetable oils and nuts) might lessen prostate risk, the study found that there was, in fact, no reduction.

The updated results, published Tuesday in the Journal of the Medical Association, take that finding one step further.

They show that study participants receiving vitamin E had a 17 percent increased risk of prostate cancer, which, according to the Centers for Disease Control, is the second-most common cancer among men in the U.S.

"The observed 17 percent increase in prostate cancer incidence demonstrates the potential for seemingly innocuous yet biologically active substances such as vitamins to cause harm," the study's authors write.

The latest report does not offer any reason why vitamin E supplements may be tied with increased prostate cancer risk.

"This was a surprising finding and, at present, there is no biological explanation for why those who took vitamin E are at higher risk of developing prostate cancer," Dr. Eric Klein, chairman of the Glickman Urological and Kidney Institute at the Cleveland Clinic and the study's lead author, told HuffPost. He added that the trial data have been made available to the wider scientific community, in the hopes that additional research will be conducted to better understand the current findings.
Read the whole report.

2 comments:

Frank said...

Robert Masters, whom you've written about here, received the diagnosis but decided not to go for treatment as his doctors advised. But then, he's way outside the "bell curve" on a lot of things...

WH said...

Thanks Frank - I didn't realize he had refused treatment. Yes, he is outside the bell curve on most things.

If I were in his shoes, I'd do the same (depending on a couple variables). I write for a researcher who specializes in prostate cancer - she says that most of the current treatments are essentially useless - what kills men is often the metastasis into the bone and none of the treatments address that.

If I am going to die from bone cancer, I'd rather not be impotent and incontinent when I do.