It's probably one of the biggest fears doctors face…overlooking cancer.
Just imagine if you were in their place - and you missed it. Having to face your patient and tell him that you just didn't see it. Or you didn't want to panic him when it could have been nothing. It may be the hardest "rock and a hard place" there is.
Unfortunately, it's probably that exact fear that's led to a severe overdiagnosis of prostate cancer over the last decade.
Earlier this month the Fred Hutchinson Cancer Research Center in Seattle released its report on a study that set out to understand why there was an unusual surge of prostate cancer that peaked in the early 90's and then went back down. Many researchers and doctors suspect the spike in these numbers may have been due to overdiagnosis, probably caused by the uncertainties of prostate specific antigen (PSA) screening.
The Seattle team developed a computerized projection of what the increase of prostate cancer might have been without prostate specific antigen (PSA) screening. Their computer model tracked a hypothetical group of two million men, aged 60 to 84. The researchers then matched their projected incidence of diagnosis with data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that tracks cancer incidence and survival data around the U.S. The projected rates of prostate cancer overdiagnosis were found to be consistent with the SEER data.
Their conclusion: using PSA screening, between 29 and 44 percent of the patients were estimated to be overdiagnosed. (The percentage varied by race. Black men suffer higher incidence of prostate cancer, though researchers have yet to discover why.)
The common denominator for all of these men, of course, is PSA screening. Elevated PSA levels provide a primary clue that something might be wrong with the prostate gland. But reading the results of PSA data is still an inexact science, partly because elevated PSA levels alone don't indicate the presence of cancer.
This is where the doctor encounters a troubling dilemma. If the PSA levels are high and other tests indicate that there are reasons to suspect cancer, no physician wants to risk missing the diagnosis. But all too often - as the Seattle test confirmed - the indicators will point to cancer, then the biopsy will come back negative.
And that would be fine if biopsy of the prostate were a risk-free procedure. Unfortunately the opposite is true. Common biopsy side effects include bleeding and infection. Moreover, surgical prostate cancer treatment can cause nerve damage that results in impotency and loss of bladder control.
Part of the overdiagnosis problem may stem from a misreading of the PSA levels. According to Dr. Charles Myers, MD, and editor of The Prostate Forum (as well as a PC survivor), there are two forms of PSA: prostate specific antigen that's bound to other proteins in the blood, and "free" PSA. The percentage of free PSA typically declines as cancer develops. Dr. Myers cites an important urologic surgery study that shows how men with a free PSA level of 25% or less may constitute a very high percentage of all prostate cancer victims. If this distinction between bound and free PSA is misunderstood or misread, it can make all the difference between an accurate and an inaccurate diagnosis.
With this important factor in the balance, the decision to proceed with a biopsy or surgical treatment should not be taken lightly. So this can't be stressed too strongly: men, if you are diagnosed with prostate cancer, be diligent in asking questions and don't be afraid to seek a second opinion. As the report of this study itself advises: "The important possibility of overdiagnosis should not be underestimated or overlooked."
Prostate cancer is the second most common cause of cancer death in men. Needless to say, every man should be taking steps to good prostate health long before his first PSA screening. Just recently I told you about a new study that showed how vitamin E can help keep prostate cancer cells from developing and spreading ("What a Long, Strange Trip it's Been" 6/17/02). Vitamin E is particularly effective in fighting prostate cancer when used with other natural treatments such as selenium and vitamin D.
Saw palmetto supplements have been shown to benefit prostate health without increasing testosterone levels. In fact, saw palmetto is even touted by the AMA and researchers at Harvard as showing great promise in the fight against prostate cancer, despite their more common stance against natural medicine.
Other prostate cancer fighters include whole flaxseed, milk thistle, and the spice curcumin (known as turmeric). All of these (including saw palmetto) are available at most health-food stores and many pharmacies. And they're all relatively inexpensive supplements that can pack a powerful punch against prostate cancer.
But one important word of caution: supplements used to increase testosterone levels may be harmful, as higher hormone levels have been associated with prostate cancer growth.
To Your Good Health,
Jenny Thompson
Health Sciences Institute
Sources:
"Overdiagnosis Due to Prostate-Specific Antigen Screening: Lessons From U.S. Prostate Cancer Incidence Trends" Journal of the National Cancer Institute, Vol. 94, No. 13, 981-990, July 3, 2002
"Prostate Cancer Incidence Trends Reveal Extent of Screening-related Overdiagnosis" Press Release, JNCI
"Cancer Facts" National Cancer Institute
"Prostate Forum / Solving the Puzzle / Prostate Cancer Screening" Dr. Charles E. Myers, Jr., MD
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