Published May 16, 2014
Prostate cancer is the most common cancer and second most common cause of death from cancer in men. It also may be the most confusing disease to manage because there are so many ways to treat it, and the studies needed to determine which treatment is best have not been done. Consequently, men are subject to the opinions and biases of the doctor treating them. Given the significant controversy, men have to educate themselves and play a role in decision-making, and it starts with the following five things your doctor may not tell you about this disease.
1. Prostate cancer isn’t always dangerous. Doctors have known for more than 30 years that prostate cancer cells are often found in men who die of other causes, and the odds increase as men get older. Cancer cells are found in about 30 percent of 50-year-old men and in well over 50 percent of men by age 80. Despite the high percentages, the odds of a man dying of prostate cancer are only about 3 percent.
2. The benefits of prostate cancer screening do not outweigh the risks. In general, the earlier cancer is discovered, the easier it is to treat. However, because many cancers are not dangerous, treating them may result in side effects without improving survival. The best study of prostate cancer screening to date has found that over a 13-year period, 781 men had to be screened and 27 had to be treated to prevent one man from dying of this disease. In other words, screening does help some men, but a much larger percentage do not benefit and may be harmed by the treatment itself.
3. Immediate treatment isn’t always necessary for prostate cancer. Doctors now realize that immediate treatment isn’t necessary for a large percentage of men because their cancer poses little threat to survival. Taking a wait-and-see approach is called active surveillance, and studies show that too few patients are being offered this option. Men should make sure they ask their doctor, “Based on my type of prostate cancer, what are the odds the cancer will harm me if I get treated, and what are they if I choose to wait and treat it only if it gets worse?”
4. Surgery is not the best treatment for prostate cancer. The fact is that surgery has never been properly compared to any of the other treatments. Surgery does have the theoretical advantage of being able to completely eliminate a cancer that has not yet spread outside the prostate gland, whereas radiation may not kill all cancer cells. However, without a proper study, doctors cannot truly say that surgery is best, and it does have a higher risk of causing problems with erections. When discussing prostate cancer treatment options, men should always ask their doctor, “What are the odds that each treatment will cause impotence, incontinence, and bowel problems?”
5. It is too early to know if newer treatments are equally effective. In recent years proton beam radiation, high intensity focused ultrasound, and stereotactic body radiation therapy have been developed to treat prostate cancer. Each has theoretical advantages, and short-term results look encouraging. However, long-term results are critical before anyone can say whether these newer treatments are as good as older options. That does not mean men should avoid them, but they should be made aware that good results at five years mean nothing with this disease because most men do just as well even without treatment. Also, the side effects are not being well studied. These newer treatments have more uncertainty about their risks and benefits, and men who want greater assurance that their cancer will be treated should choose a different option.
The bottom line is that men need to make sure they do their homework before getting tested and treated for prostate cancer. That will provide the best opportunity for making the right decision about what to do.