PSA + Digital Exam
Best at Spotting Prostate Cancer

A combination of both the blood PSA test and the digital rectal exam (DRE) appears to work best for detecting prostate cancer, according to early results [from a] Prostate, Lung, Colorectal and Ovarian Cancer Trial.

About 14% of men screened so far in the study tested positive for signs of prostate cancer. According to the researchers, 8% of men tested positive by PSA while 7% of men had a positive DRE.

Because only 1% of men had a positive result on both screening methods, the researchers say the findings support a continued need for both methods.

"We were hopeful some years ago that men could just have the PSA blood test, because men hate the DRE," [said] Dr. Gerald L. Andriole Jr., head of urologic surgery at Barnes-Jewish Hospital. "We've found that if you omit the DRE, you'll miss a certain percentage of cancers."

Low-grade prostate cancer likely not fatal

By JONAINAN BOB
The Baltimore Sun

A new study has good news for men with low-grade prostate cancer who have never had surgery to remove the gland: The disease probably won't kill them.

The study, by a urologist at the University of Connecticut Medical Center, found that men with non-aggressive tumors who were treated with hormones, or nothing at all, ran a very low risk of dying of the disease 20 years or more after their diagnosis.

An important caveat – at the time of diagnosis, their cancer was confined to the prostate gland. "if you started out with a low-grade cancer and followed it conservatively, you don't have to worry about increased mortality," said Dr. Peter Albertson, lead author of an article in this week's Journal of the American Medical Association.

The study contrasts sharply with Swedish research, published in the same journal last year, which found that untreated, low-grade tumors could suddenly turn lethal after 15 years.

Prostate cancer is the second-leading cause of cancer death among men in the United States, claiming 30,000 lives each year. Some 232,000 new cases are diagnosed annually.

Cancer experts classify as "low grade" those prostate tumors with cells that have well-defined borders. Poorlydefined cells tend to grow faster and stand a much better chance of spreading beyond the prostate, at which point the disease is virtually incurable.

"People who claim they are saving lots of lives by operating on men with low-grade disease will have to prove that, because there's no evidence they really are," said Albeitson.

The study, however, is unlikely to be the last word in an often-rancorous debate over the wisdom of surgically removing cancerous prostates.

Early prostate cancer surgery may reduce risk

By KAWANZA CRIFFIN-NEWSON
Milwaukee Journal Sentinel

MILWAUKEE - The decision on best treatment for early-stage prostate cancer is difficult, especially for younger men who have to weigh the side effects of surgery against the risk of the cancer spreading.

But for those who choose surgery, a new study shows a slight reduction in their chance of dying from the disease. There's also a decreased risk for worsening and metastasis, or cancer spread, the study found.

Still, experts encourage discussion of each option with a physician to determine the treatment that works best for each man.

"It's important to realize that prostate cancer is a very slow progressing disease," said David Jarrard, head of urologic oncology at the University of Wisconsin Comprehensive Cancer Center in Madison. "Having surgery will increase your risk of incontinence (while) radiation could cause more urinary and bowel-related side effects such as diarrhea and bleeding. But as you get older, your risk from dying from something else other than the prostate cancer increases, too."

The Swedish study, published Thursday in the New England Journal of Medicine, is a follow-up from a 2002 report. In that study, the same group showed that major surgery reduced the risk of death from prostate cancer by 50 percent and the risk of distant metastasis by 37 percent, compared to watchful waiting. That study found no difference in overall mortality between the two groups.

The current study found that 9.6 percent of men who had surgery died from their cancer compared with 14.9 percent of those who closely monitored their disease. In addition, 44.3 percent of the men who closely watched their condition had local progression of their disease, compared with 19.2 percent of men who had surgery. Distant metastasis occurred in 15.2 percent of the men who had surgery, compared with 25.4 percent of men who didn't.

The results also found that surgery was most beneficial for men younger than 65.

"Men less than 65 have a longer life expectancy, they might ... benefit more from surgery," said author Anna Bill Axelson, a urologist at the University of Uppala, in Sweden.

"But on the other hand, they may also have the most to lose with impotence and incontinence," she said. "Men without a family history of prostate cancer have a lifetime risk of 3 percent to die from prostate cancer and they have to know that."

"Are they willing to take the risk of impotence and incontinence for a benefit that might come after 15 to 20 years," she asked. "I think they have to decide that for themselves."

Ignalius Witkowski of New Berlin, Wis., was diagnosed with early-stage prostate cancer about seven years ago. He saw his physician regularly – about twice a year - but never considered he would get the disease.

While cutting the grass one day, Witkowski had a sudden urge to urinate, but didn't make it to the bathroom in time.

"I thought to myself, 'Oh my, something is wrong,'" said Witkowski, now 70.

Witkowski was referred to Stuart Fine, a urologist based at St Luke's Medical Center in Milwaukee.

After hearing his treatment options – surgery, radiation or watchful waiting - Witkowski decided to forego aggressive treatment.

Fine said that age plays a major role in treatment recommendations. Younger men are usually encouraged to have surgery, while older men are encouraged to watch and wait, he said.

Though the current study confirms what many physicians already practice, that doesn't make choosing a treatment any easier, Fine said.

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