PROSTATE SCREENINGS CAUSE DEBATE

When patients ask family physician Dr. Michael Wulfers about having an annual prostate screening, he gives them a fact sheet that explains the pros and cons of the test.

It's important for people to know that making a decision on a prostate cancer screening is not cut and dry, said Wulfers, a doctor with Physician Associated in Cape Girardeau. The screening involves a PSA blood test, which detects substances in the blood that may indicate prostate cancer, and a digital rectal exam. The American Cancer Society recommends this yearly exam for men age 50 and older. Other medical societies, including the American College of Physicians and the National Cancer Institute, do not recommend routine prostate screenings."It hasn't been proven that early aggressive treatment of prostate cancer is any better than watch and wait," Wulfers said.

Most prostate cancer is slow growing," Wulfers explained. In 40 percent to 50 percent of men age 75 and older who die of heart attacks, autopsies show they have small areas of prostate cancer."Most men, if they live long enough, the vast number will develop prostate cancer," said. Dr. Thomas S. Diemer "It doesn't mean we need to take out the prostate in all these cases."The main problem is that at this time it's difficult to detect prostate cancers which are aggressive and can kill patients in a year from the slow-growing type that may remain without symptoms until the patient dies of other causes, Wulfers said. Though he said research is being done in this area now. If as the result of a screening, a patient learns he has prostate cancer, the aggressive treatment used in the United States generally involves removing the prostate, a procedure that carries risks. One percent to 2 percent die from radical prostatectomy. The surgery also has a 25 percent risk of causing incontinence and a 60 percent chance of impotence, Wulfers said.

Treatment can lead to problems while the natural course of the disease might never cause problems, Diemer said.

A 65-year-old who gets a radical prostatectomy might have lived to be 85 without treatment, Wulfers said.

The other option is the watchful waiting philosophy used in Sweden, Wulfers said. There treatment is only begun when symptoms develop and then the treatments are more moderate. The mortality figures in Sweden are the same are better than in the United States.

But for most men watchful waiting involves tremendous anxiety."Most patients think cancer means they are going to die," Wulfers said. "People don't realize prostate cancer is usually slow."So should patients have regular screenings that can detect prostate cancer or only have a screening when there are symptoms, which can mean the cancer is already in advanced stages."Any test carries some degree of risk," Wulfers said. "You have to weigh that against the proven benefits and possible morbidity."Wulfers said patients should have a good knowledge of all that might happen if they go through the screening.

Wulfers has handouts for his patients to read before he'll schedule a screening."Most of the patients who read it, don't want the PSA," Wulfers said.

The main thing to get across, Diemer said, is you've got to know what you will do with the results before you order. If your answer is "I don't know," then you shouldn't have done."