LETTERS: MORE INFO ON PROSTATE SCREENINGS

To the editor:

I agree with Nancy Mattingly and Jeannette Fadler's Sept. 13 letter that prostate cancer is an important medical concern. However, your readers need to know that there is opposition to screening and early detection of prostate cancer within the medical community. Although the American Cancer Society currently advocates annual rectal exams and PSA (prostate specific antigen) determination for men over the age of 50, the U.S. Preventative Services Task Force, the Canadian Task Force and the American Academy of Family Physicians are all opposed to screening for prostate cancer.

Why is this so? It would seem that detecting a cancer earlier would save lives. However, prostate cancer is a strange disease, one that we do not yet fully understand. Though some prostate cancers are quite aggressive, most are slow-growing. Most men who have prostate cancer die with the cancer rather than because of it. Autopsy studies have shown that by age 70 to 79, about 50 percent of all men will have some cancer cells in the prostate gland. Opponents of screening argue that many of the cancers "cured" by early detection and treatment would have remained indolent and unlikely to produce clinical symptoms or affect survival.

More fundamentally, according to the USPSTF, no studies have shown that early detection and treatment improve survival. As a matter of fact, in many European countries, early prostate cancer is not treated, and the mortality rate there is essentially the same as that in the United States. On the other hand, the small percentage of prostate cancers that are aggressive spread so fast that the chance for cure may be lost before they can be detected in a screening program.

"First do no harm" is a time-honored dictum of the medical profession. At this point in time, we really do not know whether radical prostatectomy or treatment by radiation prolongs life. We do know, however, that both radical prostatectomy and radiation therapy have risks. Radical prostatectomy is a major surgical procedure and has a 1 to 2 percent mortality rate. Additionally, both radiation therapy and surgery can cause complications such as impotence, incontinence and urethral stricture.

Hopefully, future techniques will allow us to better determine which prostate cancers deserve treatment and which ones can be left alone. However, at the present time available tests do not allow that distinction to be made with certainty. Until then, men who choose to undergo screening for prostate cancer should be informed beforehand about its uncertainties.

MICHAEL WULFERS M.D.

Cape Girardeau Physicians Associates

Cape Girardeau