"My doctor told me that I have prostate cancer. My friends said not to worry about it. Are they right? Shouldn't I do something about it?"
No, your friends are not right. Yes, you should do something about it. You should see a urologist and seek treatment.
Prostate cancer is the most common cancer in men in the United States, and the second leading cause of cancer death in men. It is usually suspected when the PSA (prostate specific antigen) blood test is abnormal or the prostate is felt to be irregular on a rectal examination. Either one of these suspicious findings should prompt a prostate needle biopsy, which involves placing a needle through the rectum into the prostate and obtaining several pieces of prostate tissue for examination. If cancer cells are found, then the diagnosis of prostate cancer is confirmed.
The routine use of PSA blood tests and rectal examinations to look for cancer in otherwise healthy men is called screening. Screening the male population allows us to find prostate cancer before it causes symptoms and at an earlier stage, when the cancer is confined to the prostate and potentially curable.
Removing the entire prostate and reattaching the bladder to the urethra to allow normal urination is the ideal treatment for prostate cancer. This procedure is called a radical prostatectomy.
In men who have undergone a radical prostatectomy, the chances of long-term, cancer-free survival depend on the state of the cancer. The probability of cure is high when the cancer is completely confined to the prostate. For example, in a group of over 2,000 men who underwent radical prostatectomy at Johns Hopkins University in the past two decades for presumed localized prostate cancer, the actuarial survival rates free of recurrence of cancer were 84% at 5 years, 74% at 10 years, and 66% at 15 years.
So, we have and excellent treatment for prostate cancer if it is found early enough-a radical prostatectomy. We also have the means to find cancer at an earlier, more curable stage-PSA blood tests and rectal examinations. On the other hand, we also know that prostate cancer is most often found in older men and often has a long course before causing problems in men. The question then arises-is any treatment necessary?
Let's look at some numbers. In 1994, there were 200,000 new cases of prostate cancer and 38,000 men died from prostate cancer. These numbers mean that about 20% of men with a clinical diagnosis of prostate cancer die from the disease. So, death from prostate cancer is not that uncommon, and men who die from prostate cancer suffer from it in the later stages of the disease.
What is the natural history of prostate cancer if untreated? In 1994, a study from Sweden analyzed over 500 patients with prostate cancer who died in Gateberg, Sweden, from 1988 to 1990. In those men who had localized prostate cancer at diagnosis and survived more than 10 years, 63% eventually died from prostate cancer if left untreated. In those diagnosed with prostate cancer before the age of 55, 100% eventually died from the disease if left untreated.
Another major series reporting long-term results with watchful waiting, the term given to the decision to not treat prostate cancer, was reported by Johansson in 1992. This Swedish study followed over 200 patients, most of whom had the least aggressive type of prostate cancer. At 10 years, 53% of the men in this series were alive without the cancer progressing. How does this compare to patients treated with surgery? The data presented earlier show that the 10 year survival free of recurrence following surgery was 74%, far superior to the 53% progression-free survival with watchful waiting.
 | Age at diagnosis is the major factor that influences the cancer death rates in men whose prostate cancer goes untreated. Swedish studies have shown that men age 55 years, if left untreated, have a 100% chance of dying from prostate cancer if left untreated. They lose about 11 years of life to the cancer. Even for men 75 to 80 years old, 50% eventually die from prostate cancer if not treated. |
| Death from untreated localized prostate cancer occurs only after a long course. This means, there is no need to aggressively treat localized prostate cancer, such as with radical surgery or radiation therapy, in men with limited life spans. |
| However, men are now living longer. If the male patient has a reasonably long lifespan ahead of him, prostate cancer should be treated. Since localized prostate cancer progresses slowly and leads to death after a long course, there is a good window of opportunity for early diagnosis and treatment while the cancer is still confined to the prostate. |
Therefore, with improved screening techniques available today, it is possible to diagnose prostate cancer at an earlier, more curable stage. We have seen that if left untreated, men with localized prostate cancer and good life expectancies do not fare nearly as well as men who receive treatment for their prostate cancer. It is possible to reduce deaths from prostate cancer through screening, early diagnosis, and aggressive treatment.