The return of prostate cancer: A step backward
I wanted to title this blog about the return of prostate cancer, “I told you so,” but given the deadly seriousness of the topic, I didn’t think it was appropriate. Furthermore, while the recent data are only the latest to support my hypothesis, I’ll concede that the Nobel committee has yet to send me my invitation to Oslo. Yet.
What is my hypothesis? I hypothesize that as the rate of screening for prostate cancer (both by digital rectal exam and PSA) decreases, the stage of presentation of the disease will re-migrate and eventually return to what it was before any screening occurred. Sounds straightforward enough. Not screening does not cause the disease to vanish; the disease simply presents at a more advanced stage.
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What will the world look like when this new equilibrium is reached? All you have to do is look at the SEER data from the pre-screening era to form a clearer picture.
I think it’s important to remember why prostate cancer screening is such an important topic. While many contemporary physicians think of prostate cancer as a chronic disease—something that can and should be observed in the majority of men—it wasn’t always that way.
According to James L. Mohler, MD, of Roswell Park Cancer Institute, before PSA was common, the diagnosis of prostate cancer was equivalent to a death sentence. “Back then, only 4% of prostate cancers we diagnosed were curable. Now, with PSA, the cure rate is between 80% and 90%," Dr. Mohler said in an article on the Roswell Park website.
So I ask the question: Why are we taking a step backward? Why are we throwing away the best test that we currently have to screen for this disease?
Before anyone writes me, especially those of the opinion that PSA screening does not save lives (it does), let me take a moment to clarify. My hypothesis is simply that if we stop screening, more people will present with metastatic disease. But let’s save the conversation about the ability of PSA screening to save lives for another day.