Seven Things To Know About Prostate Cancer
22 Mar 2009
One: Benjamin Disraeli, Queen Victoria’s Prime Minister, once remarked "There are three kinds of lies, lies, damned lies and statistics". Disraeli, if he had been a doctor, could have been referring to the PSA test for prostate cancer. For instance, the New England Journal of Medicine has just reported a European study that showed that this blood test cut the death rate of this disease by 20 percent. But this impressive figure refers to a relative reduction in deaths.
There’s another way to look at the reduction in the number of deaths. 162,000 men were followed for 10 years. Of those given the PSA test 261 died, compared to 363 deaths of those who received routine care. A difference of 102 deaths out of 162,000 men isn’t as impressive.
Another statistic helps patients decide about the value of the PSA test. 1,410 men have to be screened by the PSA test, and an additional 48 men treated. to prevent one prostate cancer death. This means that a massive screening program would have only a modest effect on mortality and some men would get treatment and complications they didn’t need.
So statistics can be misleading or as another wise sage said, "Statistics can be used as drunken men use lamp-posts, for support rather than for illumination".
Two: How many angels can dance on the head of a pin? I don’t know the answer to this question. Nor do I, or others, know what is the best treatment for prostate cancer. One would need the wisdom of Solomon to answer this question. A young man who is believed to have a rapidly growing malignancy may be advised that a radical prostatectomy is the best chance for survival. For others, external radiation, implanting radium seeds in the prostate gland, or freezing the prostate by cryosurgery are better options. But at the moment there’s no one ultimate treatment that is the best for everyone.
Three: The late Dr. Willett Whitmore, a world authority on prostate cancer at Memorial Hospital in New York City, remarked, "The survival rate has little to do with treatment. Rather it’s related to the biological nature of the cancer". In other words, how malignant is the cancer? So pathologists try to grade cancers on how fast they grow. But it’s still an inexact science. This presents the great dilemma, how to treat or even not to treat prostate cancer?
Four: Hippocrates, the Father of medicine, always stressed when treating the patient, "First, do no harm". This is a huge problem facing doctors who treat patients with prostate cancer.
Five: Suppose you’re around 70 years of age and diagnosed with prostate cancer. It’s sometimes better to live with the devil you know than the one you’ve never met. The devil you know may be a slow growing malignancy and not destined to end your life for many years. In the meantime there’s a good chance you will die of something else. By age 70 autopsies show that about 50 percent of males have microscopic cancer cells in their prostate gland. So remember what a world famous urologist once remarked, "Growing older is invariably fatal, cancer of the prostate only sometimes."
Six: The devil you don’t know may be a horrible complication resulting from treatment such as impotence or urinary incontinence. Radical prostatectomy is the most frequent cause. Studies show that urinary incontinence is often under-reported, because the person who wets his pants is much more aware of and embarrassed by the annoyance than the surgeon who operated. Many patients who have contacted me over the years mention how difficult it is to live with this problem and would have refused the surgery if they had known of this possible complication.
Seven: Another wise sage said, "If you’re not confused about prostate cancer, you don’t know what’s going on". So my advice is to try as much as possible to be informed about this disease before submitting to treatment. Like Benjamin Disraeli, cast a wary eye at statistics. One of Harvard’s most distinguished professors often stated that "If something has to be proven by statistics, it’s usually wrong". I say "Amen" to that.
