The research shows that the incidence of prostate cancer (but not mortality) has risen in the past decade. Most experts believe this increase in diagnosis is due primarily to increased screening for the disease.
It does seem interesting that this sharp increase in diagnosis coincided with the wide spread use of the PSA blood test in the U.S.
One in six men will develop prostate cancer in their lifetime, but only one in 35 will die from the disease. Death rates have dropped during the past decade according to the National Cancer Institute (NCI). Prostate cancer is the second leading cause of cancer deaths in U.S. men. But whether to treat this cancer is controversial and a hot topic these days among oncologists.
And this is why…
Prostate cancer is primarily a disease of older men and due to our aging population, there re more men over 60 years of age than there were 15-20 years ago. We don’t see this going away as the baby boomers turn 60.
Also, research has shown that older men with early-stage disease may not be taking a risk if they wait for treatment because these men are more likely to die from another cause during the first 20 years after their diagnosis.
Risks of having treatment (surgery or radiation) raises concern due to complications such as urinary incontinence, erectile dysfunction and bowel difficulties.
The mortality rate has declined, according to the NCI since 1993. Again, is this due to early treatment or early detection?
Watchful waiting also comes with risks including the development of erectile dysfunction.
Of course there’s always the question of current reimbursement which seems to promote more treatment rather than less treatment.
Lastly, the fear of having cancer and just watching and monitoring may be unacceptable to patients and this may drive the decision-making process more than scientific evidence.
The bottom line: Men with early stage prostate cancer are probably not taking a big risk if they are under active surveillance instead of going through treatment immediately. Discuss the options with your urologist or oncologist to determine the best treatment for you.
Reference: Gelmann, EP., Lu-Yao G., et al. “Is Prostate cancer Overtreated?” HemOnc Today, Volume 9, Number 8 (May 10, 2008).