Fallacies and Pitfalls: The Prostate Cancer Narrative

 

“My doctor never checked, and he said that no one ever dies from it,” was Robert’s response when I asked him why he had never been screened for prostate cancer. At age 66, he had just retired 1 year ago from his construction job. He had recently started having right leg pain which would not go away. He saw an orthopedic surgeon, who didn’t like what he saw, and did a biopsy on his right hip joint. He did other imaging and found that there were other abnormal areas along his pelvic bone. He was facing a life threatening disease – metastatic prostate cancer (prostate cancer that has spread to sites outside of the prostate).

I was particularly bothered by Robert’s case. As a Urological specialist with a significant prostate cancer focus, I often see patients like Robert, up to 2-3 per week, who are facing the challenge of metastatic disease. Robert did everything right, saw his doctor regularly for his blood pressure and low thyroid. He was a victim of what I call the “prostate cancer narrative” – a prevailing view that prostate cancer is universally slow growing and not life threatening.

Not surprisingly, the media and the lay public have embraced this narrative. To be fair, there is validity to this viewpoint. However, this does not paint a complete picture, and many doctors have been blinded by this narrative not realizing that prostate cancer is still the second leading cause of cancer deaths, claiming 30,000 lives yearly in the U.S.

This dichotomy of a disease that can be both indolent and lethal is at the heart of the screening controversy. Urologists like me are in the trenches fighting this disease everyday, and mostly embrace screening with PSA testing (blood test specific to the prostate, but not always specific for prostate cancer) and annual prostate exams.

http://www.auanet.org/guidelines/prostate-cancer-early-detection-(2013-reviewed-for-currency-2018)
The U.S. Preventive Task Force, a government agency which shapes public health policy, has upgraded their “D” rating (more harmful than helpful) for prostate cancer screening last year, but still a very tepid endorsement for prostate cancer screening.

https://screeningforprostatecancer.org/

Robert likely has many good years ahead of him with the advanced therapies we can offer, however, I can’t help but  wonder if he could have been cured had he been screened earlier.
I encourage men over age 50 (and potentially earlier with anyone with a family history) to discuss prostate cancer screening with their doctors and seek expert opinion from a urologist.

 

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