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Published: September, 2013; Vol 10, Num 4

 

Prostate Cancer Made News This Year

Unnecessary tests. Over-diagnosis. Over-treatment. These are the kind of headlines that swirled around prostate cancer in the past year.

September is Prostate Cancer Awareness Month so this is a good time to sort through and summarize the controversy and its status.

Forming in the prostate gland of the male reproductive system, prostate cancer can be aggressive, but, more typically, it is slow growing. It is also seldom found in men who are younger than 50. The average age at diagnosis is 70.

Fish Oil

With all the data that show a strong association between the oils in some fish – omega-3 fatty acids – and lower risk of heart disease, it is hardly surprising that sales of fish oil supplements have soared. However, a new study shows a correlation between high concentrations of omega-3s in blood and a higher risk of prostate cancer. Taking daily supplements can mean overconsumption of fish oil. Researchers suggest staying away from the supplements and relying instead on eating the actual fish on a regular basis. The best fish are canned sardines, mackerel, rainbow trout and salmon. For more information, visit the American Cancer Society's website.

Controversy developed in 2012 when the U.S. Preventive Services Task Force (USPSTF) recommended against routine screening for prostate cancer using the prostate-specific antigen (PSA) test.

The rationale in favor of routine screening had been that early detection and treatment could have an impact on the quality and length of life of prostate cancer victims.

However, the test, developed two decades ago, does not actually detect prostate cancer; rather, it measures the amount of PSA in a man's blood. Some amount of PSA is normal in all men, but doctors look for elevated readings as a possible sign of cancer.

One problem with the test arises because some men develop prostate cancer without an elevation of PSA. In such cases, PSA testing merely provides assurance that is unjustified (a false negative). Another problem is that elevated results do not always indicate prostate cancer (a false positive). Additional testing is required, some of which carries its own risks.

A further problem arises from the fact that prostate cancer is typically slow growing and usually detected after age 70 so many men who develop it will never experience negative effects and will die of other causes. Despite their age, however, the worry about cancer often causes them to endure treatments to remove or curtail it. Unfortunately, these treatments can have serious side effects, including inability to control urine, bowel problems and erectile dysfunction.

On the other hand, prostate cancer can be a serious problem, even fatal, for some men. In some cases, it is aggressive and develops rapidly. It can cause urination and bowel problems as well as erectile dysfunction and other problems during sexual activity. It may metastasize (spread) to other parts of the body, in particular, bones and lymph nodes.

The development of symptoms – urinary or bowel problems, blood in urine or semen, erectile dysfunction or pelvic, lower back or bone pain – signals health providers to look into the possibility of prostate cancer. When confirmed, owing to the seriousness of possible surgical or radiological side effects, the most common treatment is careful monitoring of the disease to be sure it does not take an aggressive track. In many – perhaps most – cases, no further treatment will ever be required.

The American Urological Association has revised its guidelines and no longer recommends routine PSA screening. However, in contrast to the USPSTF, it still recommends that health providers discuss "the risks and benefits of screening" with all men, and it supports the right of any man to get PSA testing and have his insurance pay for it. It also urges symptomatic men or those at high risk for the disease (family history or African-American descent) to get regular PSA tests. The American Urological Association has revised its guidelines and no longer recommends routine PSA screening. However, in contrast to the USPSTF, it still recommends that health providers discuss "the risks and benefits of screening" with all men, and it supports the right of any man to get PSA testing and have his insurance pay for it. It also urges symptomatic men or those at high risk for the disease (family history or African-American descent) to get regular PSA tests.

A man's family history, his age, his general health and the present state of the cancer's progression all play a role in determining his comfort with screening as well as active surveillance versus a more aggressive treatment plan. According to the American Cancer Society, these are personal matters that need to be resolved through discussion with a man's health care provider. More information is available from the National Cancer Institute and the Prostate Cancer Foundation.

[Steve Clark]