No More Prostate Excuses

May 12, 2006

If lost in the wilderness, search and rescue experts will tell you the first rule is to stay put and do nothing. Help will find you.

Not true for prostate cancer. And with good reason, prostate cancer is far more fatal than most of the combined activities showcased on the Discovery Channel in any given week — crab fishing, shark feeding and rock climbing — just to name a few.

One in 32 men living in the U.S. today will die from prostate cancer. Despite the devastating news, some will tell you screening for the disease is a waste. They say prostate cancer is “overdiagnosed” and the PSA blood test often finds “insignificant” tumors (ones that have not yet spread beyond the prostate).

They assume that this kind of tumor could never cause suffering or death. However, there is no way to tell, especially in younger men, because tumors mutate and change. It’s like telling men to wait to be eaten by a shark.

The fact, according to a massive study completed in February by the University of Toronto, is nearly one-fourth of all patients opting for watchful waiting end up with advanced prostate cancer (where the chances of survival are greatly diminished) demonstrating a doctor cannot detect a life-threatening tumor in time to successfully treat it.

Annual early detection is the key to surviving prostate cancer. Since widespread use of the PSA began, deaths have dropped 33 percent, the five-year survival rate for prostate cancer has increased from 75 percent to 99 percent and incidence of advanced prostate cancer at the time of diagnosis has decreased 75 percent.

So why do some oppose the test? Money.

A PSA test with follow up biopsies can cost thousands of dollars per person and the government may be forced to pay preventative health-care costs for much of the 20 percent of American men who don’t have health insurance. This is a big reason why the National Cancer Institute (NCI) and the Center for Disease Control, leading government agencies, oppose the test and fund studies to discredit it.

The NCI actually sponsored two such studies at the University of Dartmouth. One “study” concluded men should get screened for colon cancer and not prostate cancer. The lead researcher concluded, “men who choose to be screened for cancer should be made aware by their doctor of the known benefits of colorectal cancer [screening]…and the fact that PSA testing has not been shown to reduce mortality.” Since when did cancer prevention turn into a “Choosy Mothers Chose Jiff” marketing campaign? Further, a Stanford University doctor, Thomas Stamey, made a name for himself about 18 months ago by calling the “PSA era in the U.S. over” by speaking out against the PSA test. The media called him the inventor of the PSA test, making the news even more dramatic.

The fact is Dr. William Catalona, former chief of Urology at Washington University School of Medicine in St. Louis and current director of the Clinical Prostate Cancer Program of Northwestern University’s Robert H. Lurie Comprehensive Cancer Center, was the first to demonstrate the use of blood tests detecting prostate specific antigens. In July of 2004 (two months before his remarks about the PSA came out in the news), Mr. Stamey was named to the scientific advisory board of the Health Discovery Corporation, a biotechnology company focused on creating new biomarkers for cancer.

The truth is we need a better test. Like the pap smear, sometimes it will show you have cancer when you don’t and you don’t have cancer when you do. It’s far from perfect. But we can’t fool ourselves by thinking preventative healthcare costs outweigh treatment and hospice fees for patients with late stage cancer. Nor can we attack the PSA test while research attempts to discover a better one. It’s the only test we have.

Every 17 hours, another man in Washington is diagnosed with prostate cancer. In fact, the district leads the country in prostate cancer incidence and mortality. Worse yet, only about half of all men over 50 in Washington, DC get tested for the disease. Only just recently did elected officials adopt a measure that forces insurance companies to cover prostate cancer screenings in D.C.

Before we can remove prostate cancer from any family or community, we must remove the obstacles to promising research and provide education, screening and treatment to those who need it most. To do so requires support. We can beat prostate cancer. How soon is up to the people of Washington, D.C.

Men don’t need another excuse to not get tested. Early detection saves lives — just ask any prostate cancer survivor.

Dr. Richard N. Atkins is CEO of the National Prostate Cancer Coalition, which operates the only national mobile screening program for prostate cancer.