How To Set Goals--And Reach Them
New Findings On Prostate Cancer
Every year, more than 200,000 men in the U.S. are diagnosed with prostate cancer and almost 30,000 die from it. This malignancy can be dealt with in a number of ways—surgery, radiation or hormonal therapy. Older men with localized cancers are sometimes left untreated and simply monitored for evidence of spread of the disease. But this might not be wise. In a study of about 45,000 men aged 65 to 80 with localized prostate cancer, published in The Journal of the American Medical Association, those who were actively treated within the first six months after their disease was diagnosed lived longer than those who were only observed. Although it is well known that younger patients benefit from treatment, this study suggests that older men can too.The key to successful management of prostate cancer has always been early diagnosis and treatment. Doctors usually begin routine screening at age 50 by measuring the level of prostate-specific antigen (PSA). A reading greater than 4 is considered abnormal. However, some researchers now believe that it’s best to start PSA screening as early as age 40 and to continue to do so regularly. They are also of the opinion that a rapid rise in PSA levels is more reliable than an absolute number and that such increased PSA velocity can indicate whether the malignancy is an aggressive one. Here’s a scenario that illustrates this approach: Suppose a man of 40 has a very low PSA of 0.6, and the next year it’s 1.4—still normal, but a little higher. Such a patient would then be tested again, not one year later but in three months. Should the rate of increase continue to 2.6, for example, a biopsy would then be considered. Discuss this approach with your doctor, especially if you have a family history of prostate cancer. And, equally important, don’t rely completely on the blood test; a digital exam is also important.
The findings of the JAMA were interesting. However, Johns Hopkins just reported the results of their study which indicated that: "... it is perfectly safe to wait a while before treating the desease (prostate cancer).". These findings are total contradiction. A clarification would be very helpful for Dr. Rosenfeld's readers. LK, P.B.G., Fl
As a user of a sleep apnea device I find the cost of renting the equipment and the cost of replacing various items for the equipment outrageously absurd. The obvious health care industry's greed is overwhelming. Example: Medicare is charged $11.00 to replace an air filter measuring 1 5/8 in. x 1 1/4 in. x 5/8 in. The filter needs to be replaced monthly. With the number of individuals using these machines increasing annually one would think the cost of that filter would be more reasonable. Rental of the sleep apnea machine is more than $ 200.00 per month, another example of health care greed. What can we do to curtail this seemingly uncontrollable cost/greed? John P. Trotta, Ph.D.
As with most media simplification of complex medical problems, Dr. Rosenfeld's summary of the JAMA article regarding survival associated with treatment vs observation of prostate cancer does not explain the whole story. Buried deep in the paper is another statistic which showed that only 314 of 4663 deaths in the observation group were due to prostate cancer (6.7%); whereas 612 of 7639 deaths in the treatment group were due to prostate cancer (8.0%). Thus, if you want to use statistics to make a point, this study may imply that you have a higher risk of death from prostate cancer with treatment. As with any retrospective study, you have multiple problems with drawing meaningful results. About the only thing I agree with in the study is that the only way to know for sure is to do a randomized controlled trial of the various treatment options. Please be more cautious with how you present medical data because now men who are appropriately treated with observation are going to worry that they are going to die from prostate cancer. Sincerely, David C. Horger, MD
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