from Internal Medicine 2009, the annual meeting of the American College of Physicians in Philadelphia
When the first two prospective, controlled studies to ever examine whether prostate cancer screening saves men’s lives came out in late March, and showed in one case that screening did not produce any survival benefit, and in the second case that the benefit was absurdly small, you could almost hear the collective, testosterone-laced sigh of relief.
Prostate cancer may be a scary prospect for men, but the various treatment alternatives stoke their own terror with their significant risk for causing urinary incontinence, fecal incontinence, and impotence.
The findings from these two major studies dramatically shook the prostate landscape. “Based on the information we have now, I think that prostate cancer is an investigational disease for which we don’t have the right answer of how to treat,” Dr. Marc B. Garnick said during a session on the topic.
Dr. Garnick, a medical oncologist who has spent his career studying prostate cancer, and a professor at Harvard and Beth Israel Deaconess Medical Center in Boston, recommended that men who continued to get their prostate specific antigen (PSA) level tested and find it rising and eventually receive a cancer diagnosis seriously consider the active surveillance approach. This strategy is designed for men with PSA levels of 10 ng/mL or less, a moderate Gleason score of 6 or less, and an early tumor stage of T2a or less–criteria that apply to about half of newly diagnosed prostate cancers, and defers treatment in favor of frequent surveillance. He also stressed that physicians need to clearly spell out to men the pros and cons of prostate-cancer screening (and of treatment when applicable) and let each patient decide for himself what course to follow.
Postate cancer screening and treatment are issues that strike home for men. It was why, in the waning hours of the meeting, on a balmy, late-Saturday afternoon Dr. Garnick’s talk was full of upper-middle aged men (and a few women) who hung on his words. Not many other medical topics elicit the “What would you do?” question. When one guy posed it during Q&A, Dr. Garnick replied that he wouldn’t get his PSA tested.
Then there was another fellow who came to the mic to pose the case of a 78-year old with a moderately rising PSA and some other medical issues. Is he even a candidate for a biopsy, another prostate procedure with a substantial risk for adverse effects? After hearing several medical details about this older man, Dr. Garnick said in his opinion even a biopsy wasn’t needed. “My father thanks you,” replied the physician at the mic.
—Mitchel Zoler (on Twitter @mitchelzoler)