Prostate cancer is the leading cause of cancer death in men; all avenues of detection need to be explored in addition to the traditional physical exam. It is true the PSA test is not 100% accurate in predicting cancer and a high reading only suggests the possibility of cancer. Nevertheless, high readings lead to further testing, including a prostate biopsy, which may confirm there is no cancerous tissue. Prostate biopsies today are a safe and well-tolerated procedure.
According to the NEJM, early diagnosis of prostate cancer has led to declining death rates. The incidence of metastatic cancer has gone down tenfold. PSA testing and subsequent biopsies and diagnosis have made a significant difference in men under 55.
Physicians need to act on the basis of information available today. It takes years to prove whether testing is necessary. Patients who opt for treatment are prepared to take their chances with the side effects. More than 4,000 men die from prostate cancer each year in Canada. There is much to be done in creating awareness, diagnosis and treatment. The Prostate Cancer Institute joins in the challenge to help men maintain a healthy life.
David Crowe
Where would Phyllis Kane [this letter refers to an article recommending earlier detection and treatment] be, as president of the Prostate Cancer Institute, without prostate cancer? Although this proponent of early detection and treatment (with chemotherapy, surgery and radiation) quotes the New England Journal of Medicine, she neglected to mention the paper that noted that there are no randomized clinical trials that have ever shown that early detection and aggressive treatment reduces mortality [1]. Nor did she mention the British Medical Journal report on an 11 year comparison of Seattle versus Connecticut that found that more intensive screening and more aggressive treatment in Seattle did not lower prostate cancer mortality over 11 years, but in fact increased it slightly [2].
The best way to falsely reduce the death rate from a condition is through overdiagnosis of healthy people or those with non-threatening disease. Claims of reduced mortality have to be considered very carefully to ensure that statistical bias has been eliminated.
The main sponsor of the Prostate Cancer Institute (www.prostatecalgary.com/mainpage2.html) is AstraZeneca, producer of prostate cancer drugs Casodex and Zoladex. The institute is located in the same building as all Calgary urologists and a major pharmacy. The organization may represent the financial interests of the cancer treatment industry more than the health interests of men.
[1] Barry MJ. Clinical practice. Prostate-specific-antigen testing for early diagnosis of prostate cancer. N Engl J Med. 2001 May 3; 344(18): 1373-7.
[2] Lu-Yao G et al. Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut. BMJ. 2002 Oct 5; 325: 740-3.
Jane Stewart
Executive Director, Alternative Cancer Research Foundation
I agree with David Crowe that over-diagnosis tends to skew the statistics of prostate, as well as breast cancer success rates. PSA and mammogram tests have a high rate of false positives which leads to unnecessary intervention. There are other non-invasive tests, such as thermograpy, that diagnose cancer much earlier and are more reliable. The myth that early diagnossis leads to a cure in breast and prostate cancers must be dispelled, however, as current research does not support that belief.
Instead of waiting for a diagnosis, why don’t we practise prevention through diet and supplementation (vitamins, herbs, minerals, amino acids, enzymes), exercise and stress relief techniques?
Calgary’s naturopaths, homeopaths, traditional Chinese medicine practitioners, acupuncturists, Ayurvedic doctors, nutrition consultants, reiki therapists and yoga specialists are highly trained and have much to offer in the way of wellness. Let’s make user of them.
Jane Stewart is executive director of the Alternative Cancer Research Foundation.
Copyright © David Crowe,