A Prostate a Day Keeps the Urologist Wealthy

David Crowe
Alive Magazine
May, 2004

Older men are being urged to have their prostates checked annually, especially now that the CDC claims survival rates have increased from 67% to 97% over the past 20 years¹. But this, like much prostate progress, is an illusion. Early detection and treatment is making older men’s lives more miserable and certainly not longer.

There are more prostate cancers being detected than ever before because of the introduction of the PSA (Prostate–Specific Antigen) test in 1987. This and the digital rectal exam are inaccurate and result in many unnecessary biopsies.

According to a 2001 paper in the New England Journal of Medicine², many cancers that are confirmed by biopsy are “not clinically important”. With early detection, men with benign cancers will be subject to radiation or surgery, leaving many incontinent or impotent.

The claim that men are living longer after a diagnosis of prostate cancer is true, but meaningless because of ‘lead time bias’. By detecting insignificant cancers, and by detecting important cancers earlier, the average time from detection to death will increase, but the average time from cancer formation to death might not. In fact, aggressive treatment could be causing people to die earlier (and certainly suffer more), yet this bias would still give the illusion of improvement!

If prostate cancer detection works, it should reduce deaths. Although the rate of detection has increased dramatically since 1987, deaths have risen and fallen slightly over this time, both in the United States where prostate detection is most aggressive, and also in Britain where it is not.

A 2002 study in the British Medical Journal compared a group of elderly men in Connecticut to a similar group in Seattle where the rate of PSA testing was more than five times higher³. Radiation treatment rates were more than double in Seattle, and surgical removal of the prostate almost six times more frequent. Despite this, prostate cancer death rates were similar.

Some scientists are hoping that drugs, such as Finasteride, will provide more effective treatments. A 2003 paper in the New England Journal of Medicine noted that this had reduced the rate of detection of prostate cancer⁴. However, this rate was abnormally high, meaning that the study had turned up many more insignificant cancers than normal, especially in the placebo group. Aggressive cancers, on the other hand, were significantly more prevalent in the Finasteride group.

Since there is no proof that heading to a urologist for a prostate checkup is beneficial, it is worth considering alternatives. There is evidence that antioxidants such as Selenium, Vitamins D and E, Lycopene (found in tomatoes) and Sulforaphane (found in mustard–family vegetables) may help prevent this cancer. Lower rates of this cancer in Asia may be due to increased consumption in soy products, perhaps because of the isoflavones that they contain⁵.

References

Prostate Cancer: The Public Health Perspective.
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.
Prostate specific antigen testing for prostate cancer. BMJ. 2002 Oct 5; 325: 725-6.
Thompson IM et al. The Influence of Finasteride on the Development of Prostate Cancer. N Engl J Med. 2003 Jun 24.
DePrimo SE et al. Prevention of prostate cancer. Hematol Oncol Clin North Am. 2001 Jun; 15(3): 445-57.