Prostate Cancer Seen in Younger Men
May 29, 2002 -- As doctors become better at finding prostate cancer, younger men are being told they have this potentially deadly disease. While this allows earlier treatment, some question whether this is a good thing.
From 1995 to 2001, the number of men aged 50 to 59 being diagnosed with prostate cancer jumped by 45%. Researchers presented their dramatic findings at a meeting of prostate cancer specialists.
That does not mean a new epidemic is upon us. Thanks to better awareness of prostate cancer and the use of PSA blood testing, doctors are finding more tumors, and they are finding them earlier.
PSA stands for "prostate-specific antigen," a protein produced by the prostate gland that circulates in the blood. If a blood test shows high PSA levels, it could mean that a tumor is growing in the prostate -- but not necessarily.
A high PSA level often leads to a prostate biopsy, which has led to an increase in the number of cancers detected.
PSA testing is controversial, however. While a high PSA level may indicate prostate cancer, it might also just mean that a man has an enlarged prostate -- a common, and benign, finding in aging men.
Many doctors check PSA levels in men starting at age 50 -- or earlier in men at high risk, such as blacks or men with a family history of prostate cancer. But some experts don't think all men over 50 should be screened. Prostate cancer grows so slowly that men often die "with it, not of it," so it's possible that early detection may not lead to fewer deaths.
Studies are being done now to find out whether that's true, but they will take a long time to complete. According to urologist Myron Murdock, MD, even results from a 10-year study might not give us the answers that we need. Again, that's because prostate cancer can grow for so long before it becomes deadly.
Lacking a clear answer, a better-safe-than-sorry policy seems to make sense. "They used to have arguments like this about Pap smears," says William Catalona, MD, professor of urology at Washington University in St. Louis. Now, women are told to get them yearly to check for abnormalities of the cervix that could become cancerous.
Nevertheless, "A consequence of screening is that you're going to overtreat the disease," says Gerald Chodak, MD, of the University of Chicago. "We run the risk of doing a lot of harm to people."
Prostate cancer treatment -- surgical removal of the prostate or radiation therapy -- can leave a man impotent or incontinent. If you're 50 years old and in otherwise good health, you might spend the next two decades dealing with those consequences. A less compelling argument to patients, but a dear one to the healthcare industry, is that screening and treatment cost a lot of money, which may turn out to be wasted if deaths are not prevented in the long run.