The New England Journal of Medicine, yesterday, published results of a study on prostate cancer and the various treatment regimens employed. I selected this as today's topic since I'm a man, I've had friends who've died from the disease, I have friends who now have the disease, I'm in the target age group and fully one in six males will be diagnosed with prostate cancer.
Prostate cancer is the most common form of cancer in men and the number two killer second only to lung cancer according to the American Cancer Society. It is predicted that there will be some 186,000 diagnoses this year and some 28,700 deaths are expected from the disease.
The New England Journal of Medicine reported on the study of a group of 1,201 men and their partners after three kinds of treatment had been administered. Those were: removal of the prostate; implantation of radioactive 'seeds'; and, radiation therapy. Of the group who had received either radioactive 'seeds' or radiation therapy, one-third also took hormones. The Journal was careful to note that the patients and doctors had made decisions independent of this study so the conclusions drawn were said to be suggestive rather than conclusive.
The conclusion drawn by the urologist who led this study, Dr. Martin Sanda of Beth Israel Deaconess Medical Center in Boston, was this (as he was quoted saying): "Doctors or their patients should think twice if they're considering hormone therapy. Most of the cancers treated nowadays are not really that aggressive."
The good news is that more than 99% of patients survive at least five years. Thirty years ago, only about two-thirds survived that long.
This study showed that too much treatment can make a patient needlessly miserable. Complaints with hormone therapy centered on lack of sexual drive, problems with urination and bowel problems.
I remember very well my conversations with my friend John, of whom I've written before. He was adamant that the quality of his life was more the issue than the length of his life. He was encouraged to take hormone therapy and refused to do so after reading of the possible side effects. He knew that was the right decision for him and maintained his quality of life until very near the end.
What lesson can we all draw from this? I think the most important lesson is this: Men should not avoid being examined for prostate enlargement and PSA counts for fear of what might be detected. That is a very, very small price to pay for the peace of mind that flows for most of us as the result. And, early detection is by far and away better for the patient because treatment can be begun before the cancer has grown too large to control.
The rule of thumb that I've always heard was that we men should begin to be examined for prostate issues at age 50. My feeling is that even earlier would be better. My friend was diagnosed at about his age fifty and the cancer had already gotten a good start by that time.
