Concern About Treatment
The decision to screen for prostate cancer assumes a decision to treat, if cancer is detected. Several options are available for treating early-stage prostate cancer, that is, when it is still confined to the prostate gland. But, after it has spread beyond the gland, options are limited, and there is little chance of curing it. T First, how is prostate cancer staged after it is detected. Unfortunately, this is a very inexact science. About one-half of men thought to have early disease are found at surgery to have more extensive disease. And, it is virtually impossible to know for sure whether microscopic cancer cells may have escaped the prostate. At this time, it is very hard for surgeons to know if they removed all of the cancer.
Second, the major treatment options are surgery, radiation, and brachytherapy. Surgery is frequently used in younger men, based on its potential to cure the disease, and the higher likelihood that it has not spread as far. Radiation is generally reserved for older men. Brachytherapy, a treatment in which very small radioactive “seeds” are inserted in the prostate, is used for men of all ages who have localized prostate cancer. All treatments usually cause some complications; generally somewhat worse with surgery. The two biggest problems with surgery have to do with urinary function and sexual function. These are less affected by radiation, but rectal problems are more common. Urinary function disruptions are common with brachytherapy.
Third, there is no definitive evidence at this time that any treatment reduces the chance of death or increases survival. At this time there simply are no good, long-term studies comparing the various approaches to treatment. There are studies that suggest a small survival advantage, but men have not been randomly assigned to treatments and have not been followed long enough. This is the downside of the generally slow growth of prostate cancer -- it takes a long period of follow-up to document that survival is improved with treatment. And to be valid, such studies need to assign men randomly to the various types of treatment so that there would be no differences in those getting surgery, radiation, brachytherapy, or no treatment. Such studies are now in progress, but it will be many years until the results are available.
So the treatment decision is actually much tougher than the screening decision, but the person will have to be ready for it if the decision is made to go through screening. There are psychosocial and quality of life issues that must be considered.
