About 1 in 8 men will get prostate cancer in their lifetime.
But a new study concludes an increasing number of men with limited life expectancy are being overtreated for the disease with procedures that can cause unwanted side effects without adding more years to their lives.
Dr. Parth Shah, a urologist with Texas Health Southwest Fort Worth explains his concerns about the study to KERA’s Sam Baker.
We've learned a lot about prostate cancer over the past 15 to 20 years. We know that many forms are very slow-moving and they may not have a long-term impact to your longevity or life expectancy. And so the big push as a field is to monitor prostate cancers if they're not aggressive.
The real notable thing in this study was that patients with more aggressive cancers that perhaps wouldn't live that long did get treated. And that's what authors are saying is overtreatment of prostate cancer.
Are you saying the appropriate treatment would have been to just simply monitor them?
The authors in this paper would argue that men with aggressive prostate cancer that we think may not live ten years should be just monitored and to not do anything about their cancers.
I think that's a valid thought to have when writing a paper or in a research setting. But when you have patients that are in your office that we've found to have aggressive prostate cancer and we just tell them, "Hey, we should monitor it", the impact of that diagnosis and the stress involved takes a toll on patients.
And so I could see why patients would want to be treated and not let the disease control the narrative.
Which explains why this problem is occurring at all.
Quite frankly, you know, monitoring and not doing anything also requires follow-up and repeat doctor appointments and visits, which can also take their own toll.
So, yes, I think we should be careful and not overtreat patients. But at some point, you know, it is a shared decision between the patient and the physicians that are guiding the treatment on what is in the best interest of the patient.
For men with limited life expectancy, you should monitor or it just depends upon the patient?
Well, I think it would be interesting to understand how these patients that were in this study were diagnosed with the prostate cancer in the first place.
Were the patients having urinary symptoms? Was it difficult for them to urinate? Was a cancer causing a blockage of the outflow of urine? You know, is that why they detected it and is that why they were treated? So, there are so many unknowns kind of based on the study.
And, you know, in some ways the study is important, but to me, it's not very earth shattering because it leaves some of these big questions as to why some of these, you know, limited life expectancy patients were screened for prostate cancer in the first place.
So, I can rationalize and understand many reasons why patients would get treated for prostate cancer, especially if they're having local symptoms. In the study, the authors would say the patient was overtreated. Well, they were probably appropriately treated because treating the cancer probably solved a physical problem. And that's some of the limitations of the study. It's not very clear as to what prompted these patients to get treated in the first place.
What are the recommendations about screening for prostate cancer? Who should get it and when?
Current guidelines state that if you're a man at the age of 50, you should get a blood test — it's called a PSA number — unless you have a higher risk of developing prostate cancer. So perhaps it runs in your family, or we know African American men can harbor more aggressive prostate cancer, you should be getting screened at the age of 45.
Once a year, until how long?
We're getting more and more greater data that says that, hey, if your initial blood test is really low, 2.5, that's the level of the PSA. If it's below that, then maybe we watch and get repeat blood tests every couple of years. If you're above that 2.5, we should get a blood test every one year. You know, the whole goal of this is to not overdiagnose people with problems that may not have a consequence. But certainly, we don't want to miss cancers that can be treated and cured at the localized stage either. So, this is a balance between, you know, the population at large as well as each individual person.
Still, what are signs and symptoms that you should watch out for?
Prostate cancer, like many of the other cancers that we screen for, is asymptomatic. So, it typically may not cause any symptoms at the initial stages, and that's why screening is so important. Some men may report changes in how they urinate. Perhaps they urinate too frequently. Perhaps they feel like a decrease in stream.
But some of these changes can also overlap with the nature of aging itself. So there is a crossover between these symptoms of aging and prostate cancer, and that's why screening is so important.
RESOURCES:
What Is Aggressive Prostate Cancer?
Study: Older Adult Prostate Cancer Patients Are Increasingly Being Overtreated
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