A New Approach to Prostate Cancer

It’s been 20 years since the FDA approved prostate-specific antigen (PSA) tests as an aid in diagnosing prostate cancer. Hailed at the time as a revolutionary breakthrough in the fight against cancer, more than 1 billion PSA tests have been performed in the past 20 years. But in the last few years there’s been a radical change in how the medical community views these tests, as new guidelines have emerged regarding the diagnosis and treatment of prostate cancer. The new approach to this disease recommends not testing PSA levels in men over age 60. There are several reasons for this: First, PSA tests have a high false-positive rate, as symptoms such as benign prostatic hyperplasia (or an enlarged prostate) can lead to elevated PSA levels. According to the Mayo Clinic, about 75 percent of men with a “positive” PSA test actually have cancer. Also, these false-positive tests can cause great anxiety in men, when there may be no cause for concern. On the other hand, an unspecified number of these tests turn out false-negative; the PSA numbers on the test come back fine, but the patient actually has prostate cancer.

Another new approach in the fight against prostate cancer is not to treat patients age 65 or over, because the diagnosis and treatment is associated with more morbidity and mortality than the disease itself. The morbidity, or negative symptoms, includes urinary and fecal incontinence, testicular pain, and impotence, among others. The urologists who derive much of their income from diagnosis and treatment of this disease probably do not want to hear these facts, but they’re established knowledge. The medical community has known for some time that prostate tumors grow very slowly, and many never spread beyond the gland. One study announced in 2013 revealed that in post-mortem necropsies of men over age 60 who died of causes not related to prostate cancer, more than half had prostate tumors. In other words, they died with prostate cancer, not from it. Now, it’s important that you have a discussion with your physician about whether or not to check your PSA levels, and what to do if the levels register as elevated. Certain groups are much more at risk and require extra caution. The most aggressive prostate cancers occur in African-Americans and men with a family history of a first-degree relative (father, brother) who had an aggressive prostate cancer at a young age.

The up-and-coming treatments and preventative measures include the use of metformin — traditionally a medication for diabetes — finasteride and dutasteride (medications commonly used for benign prostate hypertrophy). But once again, just as with the PSA tests, the efficacy of these drugs in fighting prostate cancer has not been established. For example, a study reported in an August 2013 issue of the New England Journal of Medicine found that men with prostate cancer who took finasteride had almost identical long-term survival rates to those who took a placebo.

The bottom line in the new approach to fighting prostate cancer: As the old saying goes, sometimes, the cure really is worse than the disease. But always remember to consult with your physician concerning the right course of action for your specific risks of prostate cancer.