Tuesday, May 01, 2012

Prostate Cancer: Watchful Waiting May Be Best

MRI showing prostate cancer in a 75 year old male.
 Photo: The Telegraph
So, the second leading cause of cancer death in men is prostate cancer. And although screening and surgery are the recommended course of action for the 3rd leading cause of cancer death in men, colorectal cancer, that's not turning out to be the case for prostate cancer.

Early results of the PIVOT study (Prostate Intervention Versus Observation Trust, 731 participants over 12 years) show that those who had their prostate gland removed had no better chance of survival than those who had no treatment:

Prostate Cancer Surgery 'Has No Significant Survival Benefit', Study Suggests, The Telegraph, 28 April, 2012

Dr. Kate Holmes, head of Research Management at the UK's Prostate Cancer Charity, said:
"Early data from the PIVOT trial certainly suggests that surgery to remove the prostate does not provide any significant survival benefit for men with low to medium risk prostate cancer."
"Watchful waiting" is not the kind of finding that excites for-profit health providers. Indeed, even though, according to the US Preventive Services Task Force, the PSA test:
"... results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary."
And even though the test is unreliable - positive results are mostly false ("7 out of 10 men in this category will still not have prostate cancer") and 25% of men with prostate cancer have no elevation in PSA - the test is still aggressively promoted.

I don't know, this is a tough one. Maybe, as the CDC says, it's best left to each man and his provider.
"Currently, there is not enough evidence to decide if the potential benefits of prostate cancer screening outweigh the potential risks. Given the uncertainty about the benefit of screening, CDC supports informed decision making."


John said...

Reduce your risk in the first place. Eat less meat and dairy.

caulfieldkid said...

I have to say, compared to breast cancer, we've done a very poor job of promoting awareness, prevention and raising funds for research in regards to prostate cancer.


P.S. I think I would take my chances with the "watchful waiting" approach.

Bix said...

Takes courage to say that, John. I admire yours.

Bix said...

Excellent treatment of this topic by Naomi Freundlich:

On Prostate Cancer Screening, Warren Buffett and Ignoring Science



Bix said...

To back up John's assertion ... Here a 2001 Harvard review of the body of evidence at that time on dairy intake and prostate cancer:

Dairy Products, Calcium, and Vitamin D and Risk of Prostate Cancer

"Seven of 14 case-control and five of nine cohort studies have reported statistically significant positive associations between some aspect of dairy intake and prostate cancer risk. Overall, 12 of the 14 case-control studies and seven of the nine cohort studies observed a positive association for some measure of dairy products and prostate cancer; this is one of the most consistent dietary predictors for prostate cancer in the published literature."