THE PROSTATE CANCER SCREENING TRIALS DEBATE: A CALL TO ACTION
Statement By: Thomas A. Farrington
Thomas A. Farrington
The recently released results from prostate cancer screening trials in the United States and Europe may not have resolved the question of the overall benefits and effectiveness of annual prostate cancer screening for the masses, but they certainly bring much needed attention to the plight of men at the mercy of the severe flaws and limitations of today's procedures for combating this deadly disease.
To grasp an appreciation of the meaning of the data released it is necessary to understand some important facts surrounding prostate cancer detection and treatment from a human perspective and facts about the report itself.
FACT: Prostate cancer is the leading cause of any major cancer among men in the United States with 200,000+ diagnoses annually. With approximately 28,000 deaths annually it is the second leading cause of cancer deaths among men. This means that during the six years while the US has been at war in Iraq where we have lost approximately 4,500 men, this country has lost 168,000 men in the war against prostate cancer.
It is critically important to focus on the deaths from prostate cancer because widespread comments that the disease is "slow growing" may lead to a false conclusion that all men will likely die from other causes before they die from prostate cancer and that there is no urgency of action. The death statistics speak clearly to this issue and tell another story. Also, one must understand that death from prostate cancer is a horrible death that does not come overnight. Because it is a slow growing disease death usually comes slowly but steadily over many years of debilitating pain and suffering caused by the cancer spreading to the bones and other organs in the body. Death finally comes after your quality of life is totally destroyed. All during this time the victim and his family are also subjected to mental anguish, economic hardships and an overall feeling of helplessness. Therefore a proper perspective of prostate cancer devastation should also focus on the quality of life factor of the millions of men surviving and living with this disease. Men are screened in an attempt to preserve both their lives and quality of life.
FACT: African American men are diagnosed at a rate 60% higher and die at a rate 150% higher than all other men in the US from prostate cancer. This is the largest racial disparity for any type of cancer. All African American men, along with men with a family history of prostate cancer are designated as being at high risk for the disease. This means that there are many millions of men in this high risk category in the US. Only 4.5% of the subjects in the US screening trial were black men and 7.1% of all the men had a family history of prostate cancer, meaning that in excess of 90% of the men in the trial were not in a high risk group.
I am a nine year African American prostate cancer survivor. My father and both grandfathers died from the same disease and prostate cancer still terrorizes my family with other family members being diagnosed on a continuing basis. I have had a close up view of prostate cancer horrors most of my life. I personally know a number of other families in the same predicament. Can we dare roll the dice and not be screened regularly for a disease that we know firsthand as a debilitating killer? What are our options? I consider the release of any data on the benefits and risk of prostate cancer screening that does not speak directly to the needs of high risk men, and the relevancy of the data to these men, as being irresponsible because there is a significant risk of confusing and misleading. With the small number included I don't see how this screening trial can be considered relevant to high risk men.
FACT: Prostate cancer can be cured and quality of life protected with early detection and proper treatment. I personally know prostate cancer survivors, including myself, that have faced the disease successfully without any major side effects from treatment. We all benefited from early detection and knowledge about treatment options. Dr. Otis Brawley, American Cancer Society, was quoted in the "Washington Post" newspaper as saying "I know guys who are morbidly depressed because of the complications of their prostate cancer treatment...I know three people who attempted suicide...I know widows of guys who died from their treatment..." I find it interesting to note that Dr. Brawley has not seen men cured from prostate cancer, nor has he seen men dying from the disease because they were diagnosed too late, or men who had biopsies that showed no cancer only to learn too late that the biopsies were incorrect. When Dr. Brawley mentions men "morbidly depressed" because of treatment I assume he is referring to impotence and incontinence complications, however, I have seen men with later stage diagnosis choose to take themselves off chemotherapy treatment to face death. You see there are two sides to the flaws in today's early detection and treatment procedures. We must guard against a rushed and unbalanced reaction to the release of the screening trial data creating a worse problem than we currently face. In fact annual data published by the American Cancer Society shows that deaths from prostate cancer have steadily decreased since widespread use of the PSA screening test starting in the early 1990's. How do you balance this fact with the incomplete US trial data? Can it be summarily dismissed as irrelevant?
FACT: Prostate cancer screening was available to all men in the US screening trial. The distinction was that the "screening" group received annual screening and the "control" group periodic screening. In fact at the sixth year of the trial there was only a 32% difference in the screening regimen between the two groups. Prostate cancer was detected in both groups via screening and similar treatments were provided to men in both groups. 89% of the men in the annual "screening" group diagnosed with prostate cancer chose to be treated while 90% of those men diagnosed in the "control" group chose treatment.
Media reporting on the results of this trial are misleading the public into thinking that one trial group was screened and treated for prostate cancer while those in the other group were not screened nor treated. This is not the case at all, but it is prompting the question; "why be screened or treated for prostate cancer if there is no benefit?" This is a clear example of the harm that can come from rushed and unbalanced statements on the data from this incomplete trial.
The prostate cancer screening debate seems destined to be continued. However what should not be lost with the release of the data from the US and European screening trials are that men desperately need help now in our fight against prostate cancer, and debate should not halt actions. We need better and more accurate early detection tests, and better treatments today. African American men are facing a prostate cancer epidemic of crisis proportion that should not continue to be overlooked; the suffering in these families is more than twice that of others and needs to be addressed with aggressive actions now.
The federal government should treat the release of the screening trial data as a call to much needed action on the prostate cancer crisis. The fight against prostate cancer should be given the high priority that it deserves as the leading major cause of cancer for men. The government should fund additional research and accelerate approval of new less invasive treatments. With a growing call for "informed decision making" for prostate cancer screening, men, especially men at high risk, must be armed with the knowledge they need to participate with their doctors in decisions about screening, treatments and survivorship. There must be decisive and aggressive actions taken to create a future where prostate cancer is a managed disease with much less death and suffering than we are witnessing today; a future where our sons and grandsons are much safer.
Thomas A. Farrington is the founder and president of the Prostate Health Education Network, Inc.