To test or not to test for prostate cancer

Jun 11 2012 - 3:13pm

Last month, the U.S. Preventive Services Task Force recommended physicians stop ordering routine tests to detect prostate cancer in men.

The risks, says the study group, outweigh the benefits.

Howls of protest followed from various physicians groups, including an adamant dismissal of the recommendation by Irvine, Calif.-based radiation oncologist Dr. Kenneth M. Tokita.

Tokita insists all men should have an initial prostate-specific antigen test at age 40 to determine their risk level for cancer.

Q: Why are you advocating this testing?

A: The percentage of men with advanced prostate cancer at the time of diagnosis has decreased by 75 percent in the U.S. since the PSA era began in the late '80s. Death rates have fallen in the U.S. and globally since the testing began. Still, prostate cancer is the second most common cause of cancer deaths in the U.S. Even with this statistic, deaths have decreased by 37 percent and American men are now living eight years longer.

Q: Does PSA testing do more harm than good, as some experts say?

A: We now know that almost any man living to be 90 will get prostate cancer. The percentage is staggering, but it is very curable.

However, if you don't know you have cancer, you can't make a decision about your own care. If you wait until the PSA is too high, the cure rate drops dramatically. If the PSA is low, the cure rate approaches 95 percent today.

Q: Doesn't this cancer grow slowly?

A: Indeed, some prostate cancers grow slowly, but experienced urologists and radiation oncologists are well aware of those they can comfortably watch and those that better be treated. The aggressive ones are very dangerous, but fortunately can now often be treated if picked up early enough.

Q: Are the complications of treatment greater than the complications seen in a man with metastatic cancer disease and death?

A: The complication rates today of radiation and surgery are very low and in the single digits, percentage-wise. We know 100 percent of uncured patients will suffer serious consequences of bone pain, tremendous amount of medical treatment and agonizing deaths.

In 40 years, I have seen prostate cure rates rise from 0 percent in the early 1970s to more than 90 percent overall today.

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