PROSTATE CANCER: Testing, Treatment May Be Overused
In the latest example of a clinical practice that has become widely accepted before its efficacy is proven, The New Republic questions calls for more prostate cancer screening in light of its known costs and unclear benefits. Though the Prostate Specific Antigen test costs just $45, and detects cancer an average of 11 years earlier than other methods, if all men aged 50-70 were tested, the cost for treatment could reach $27.9 billion, despite the lack of evidence that treatment saves lives. Standard treatment is total surgical removal of the prostate gland, but 88% of men who undergo surgery are impotent a year after surgery, up to one-half experience permanent sexual dysfunction and about a third are incontinent. Moreover, up to 96% of men with prostate cancer live 15 years after diagnosis, even without surgery or radiation. Though men whose biopsies show high levels of cancerous cells benefit from surgery, those with few cancerous cells may benefit most from alternative treatments such as radiation, hormone therapy or a watch-and-wait approach. Dr. Gerald Chodak, a urologist at the University of Chicago, said, "Most men overestimate their chances of dying, overestimate the effectiveness of treatment and underestimate the side effects." Experts have suggested that tests that distinguish between deadly and benign cancer, definitive clinical trials comparing treatment options and a public awareness campaign by the National Cancer Institute would be better strategies for improving care (Brownlee, 3/22 issue).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.