		Thomas S. May, M.A. Medical Writer
Home Portfolio Contact		Surviving Prostate Cancer: Early Detection is the Key, Recent Studies Find *By Thomas S. May, Medical Writer* Early diagnosis and treatment of prostate cancer can cut mortality rates by as much as 69%, according to an article published in the May 15, 2000, issue of The Prostate. Based on an analysis of four previously published studies, the author, Dr. Fernand Labrie of Laval University in Quebec City, Canada, concluded that "simple use of the available screening procedures and treatments for localized prostate cancer could cause a dramatic decrease in prostate cancer death." The difficulty in detecting prostate cancer lies in the fact that it "almost always develops insidiously, without any signs or symptoms, until it reaches the noncurable stage of metastases in the bones," Dr. Labrie explains. "Early treatment or cure of prostate cancer will never be possible without screening in asymptomatic men," he adds. Catch it before it spreads Although not all experts are convinced yet, there is growing evidence that routine screening of middle-aged and older men using currently available tests, such as digital rectal examination (DRE), prostate-specific antigen (PSA) test, and transrectal ultrasonography of the prostate (TRUS), results in a significant decrease in prostate-cancer related mortality. For example, one of the studies analyzed by Dr. Labrie found that prostate-cancer related death rates have been reduced from 48.7 per 100,000 man-years in unscreened men to just 15 among those who have been screened and treated for the disease between 1989 and 1996. Similar results were obtained in another recent study presented by Dr. Georg Bartsch of the University of Innsbruck, Austria, at the 95^th annual meeting of the American Urological Association (April 29 - May 4, 2000). Dr. Bartsch and his team have found a 48% decrease in prostate cancer death in the state of Tyrol, following the introduction of freely available PSA testing for men between 45 and 75 years of age in 1993. Since there was no similar reduction in death rates in the rest of Austria during the same time period, the researchers concluded that the reduced mortality in Tyrol was caused by the widespread introduction of PSA screening in that state. However, some experts believe that it might be premature to come to such a conclusion, based on the available data. For example, Professor Ulf-Hakan Stenman of Helsinki University Central Hospital in Finland has told CBS HealthWatch that "it will take 15-20 years after the start of a screening program before we can evaluate whether it reduces mortality." The reason for this is that "serum PSA starts increasing 5-10 years before prostate cancer causes any symptoms, and on average, 17 years before the patient dies of this disease," Dr. Stenman said. Dr. Stenman and his colleagues are presently conducting a randomized clinical study of over 38,000 middle-aged Finnish men. Approximately 10,000 of these men have received PSA screening, while the remaining subjects have not been tested. Although it is too early to tell if the screening will result in reduced mortality, preliminary results indicate that "PSA testing results in an improved stage distribution." So far, the researchers have found that only 14% of the cancers detected in the screened group had spread beyond the prostate at the time of diagnosis; whereas, in the control group (which received no intervention), 33% of the cancers had already metastasized by the time they were diagnosed. Who should be tested? According to most clinical guidelines, men who are at high risk for developing the disease (e.g., African Americans and those with a family history of prostate cancer) should first be screened at age 45, although some experts recommend screening as early as age 40 for men in the high-risk category. Others can be screened starting at age 50, most experts believe. Initial screening usually includes both digital rectal examination (DRE) and prostate-specific antigen (PSA) testing. Unfortunately, both of these tests have rather low specificity, which means that the results may be positive even when the patient does not have cancer. However, a newer, more accurate test called "percent free PSA" has recently been approved by the US Food and Drug Administration for the early detection of prostate cancer in men with elevated PSA levels. It is hoped that the widespread use of this test will help cut down the number of "false positive" results and unnecessary biopsies in the future. To treat or not to treat? Naturally, everyone hopes for the best possible outcome when undergoing any medical test or examination, but what happens if one or more of the tests indicate the possible presence of a cancerous tumor? Deferred treatment, or so-called "watchful waiting," has often been recommended in the past, particularly for older men who have been diagnosed with low-grade prostate cancer. The reasoning behind such advice is that cancer of the prostate tends to progress slowly, and older men, especially those over 70 years of age, may die of unrelated causes before the cancer has a chance to spread to other areas of the body, resulting in serious illness or death. Dr. Labrie of Laval University points out, however, that although prostate cancer usually progresses slowly, it eventually leads to distant metastases and death, if left untreated. He agrees that watchful waiting might be considered for some men, such as those "having a short life expectancy and diagnosed with low-grade localized disease." But he believes that for the vast majority of cases "the benefits of treatment of localized prostate cancer at time of diagnosis have been well documented." Home Portfolio Contact

Thomas S. May, M.A.

Medical Writer

Surviving Prostate Cancer: Early Detection is the Key, Recent Studies Find

By Thomas S. May, Medical Writer

Early diagnosis and treatment of prostate cancer can cut mortality rates by as much as 69%, according to an article published in the May 15, 2000, issue of The Prostate. Based on an analysis of four previously published studies, the author, Dr. Fernand Labrie of Laval University in Quebec City, Canada, concluded that "simple use of the available screening procedures and treatments for localized prostate cancer could cause a dramatic decrease in prostate cancer death."

The difficulty in detecting prostate cancer lies in the fact that it "almost always develops insidiously, without any signs or symptoms, until it reaches the noncurable stage of metastases in the bones," Dr. Labrie explains. "Early treatment or cure of prostate cancer will never be possible without screening in asymptomatic men," he adds.

Catch it before it spreads

Although not all experts are convinced yet, there is growing evidence that routine screening of middle-aged and older men using currently available tests, such as digital rectal examination (DRE), prostate-specific antigen (PSA) test, and transrectal ultrasonography of the prostate (TRUS), results in a significant decrease in prostate-cancer related mortality. For example, one of the studies analyzed by Dr. Labrie found that prostate-cancer related death rates have been reduced from 48.7 per 100,000 man-years in unscreened men to just 15 among those who have been screened and treated for the disease between 1989 and 1996.

Similar results were obtained in another recent study presented by Dr. Georg Bartsch of the University of Innsbruck, Austria, at the 95^th annual meeting of the American Urological Association (April 29 - May 4, 2000). Dr. Bartsch and his team have found a 48% decrease in prostate cancer death in the state of Tyrol, following the introduction of freely available PSA testing for men between 45 and 75 years of age in 1993. Since there was no similar reduction in death rates in the rest of Austria during the same time period, the researchers concluded that the reduced mortality in Tyrol was caused by the widespread introduction of PSA screening in that state.

However, some experts believe that it might be premature to come to such a conclusion, based on the available data. For example, Professor Ulf-Hakan Stenman of Helsinki University Central Hospital in Finland has told CBS HealthWatch that "it will take 15-20 years after the start of a screening program before we can evaluate whether it reduces mortality." The reason for this is that "serum PSA starts increasing 5-10 years before prostate cancer causes any symptoms, and on average, 17 years before the patient dies of this disease," Dr. Stenman said.

Dr. Stenman and his colleagues are presently conducting a randomized clinical study of over 38,000 middle-aged Finnish men. Approximately 10,000 of these men have received PSA screening, while the remaining subjects have not been tested. Although it is too early to tell if the screening will result in reduced mortality, preliminary results indicate that "PSA testing results in an improved stage distribution." So far, the researchers have found that only 14% of the cancers detected in the screened group had spread beyond the prostate at the time of diagnosis; whereas, in the control group (which received no intervention), 33% of the cancers had already metastasized by the time they were diagnosed.

Who should be tested?

According to most clinical guidelines, men who are at high risk for developing the disease (e.g., African Americans and those with a family history of prostate cancer) should first be screened at age 45, although some experts recommend screening as early as age 40 for men in the high-risk category. Others can be screened starting at age 50, most experts believe.

Initial screening usually includes both digital rectal examination (DRE) and prostate-specific antigen (PSA) testing. Unfortunately, both of these tests have rather low specificity, which means that the results may be positive even when the patient does not have cancer. However, a newer, more accurate test called "percent free PSA" has recently been approved by the US Food and Drug Administration for the early detection of prostate cancer in men with elevated PSA levels. It is hoped that the widespread use of this test will help cut down the number of "false positive" results and unnecessary biopsies in the future.

To treat or not to treat?

Naturally, everyone hopes for the best possible outcome when undergoing any medical test or examination, but what happens if one or more of the tests indicate the possible presence of a cancerous tumor?

Deferred treatment, or so-called "watchful waiting," has often been recommended in the past, particularly for older men who have been diagnosed with low-grade prostate cancer. The reasoning behind such advice is that cancer of the prostate tends to progress slowly, and older men, especially those over 70 years of age, may die of unrelated causes before the cancer has a chance to spread to other areas of the body, resulting in serious illness or death.

Dr. Labrie of Laval University points out, however, that although prostate cancer usually progresses slowly, it eventually leads to distant metastases and death, if left untreated. He agrees that watchful waiting might be considered for some men, such as those "having a short life expectancy and diagnosed with low-grade localized disease." But he believes that for the vast majority of cases "the benefits of treatment of localized prostate cancer at time of diagnosis have been well documented."

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