| The report, in the September 2009 edition of the | | | | Almost 10,000 men die from prostate cancer in the UK |
| Journal of the National Cancer Institute estimates 1.3 | | | | each year, having received either inadequate |
| million additional men have been diagnosed and treated | | | | treatment or were beyond curative intervention at the |
| for prostate cancer since 1987. Authors claim most of | | | | time of diagnosis. Furthermore, a massive European |
| this group are likely to have been overdiagnosed. | | | | study has shown that testing a man's PSA can |
| "Given the considerable time that has passed since | | | | reduce the chance of dying from prostate cancer by |
| PSA screening began, most of this excess incidence | | | | around 20 per cent or more. |
| must represent overdiagnosis," the authors write. "All | | | | So what strategies should we follow? As it turns out, |
| overdiagnosed patients are needlessly exposed to the | | | | more specialists try to direct men with prostate cancer |
| hassle factors of obtaining treatment, the financial | | | | to active monitoring, which is intense observation, when |
| implications of the diagnosis, and the anxieties | | | | there is enough doubt that surgery or radiotherapy is |
| associated with becoming a cancer patient..." | | | | needed. |
| The increased diagnosis has been most dramatic | | | | This tactic avoids "overtreatment" but hopefully keeps |
| among younger men: more than tripling since 1986 in | | | | the window still open for successful surgery or |
| men aged 50-59 (from 58.4 to 212.7 per 100, 000) and | | | | radiotherapy if the need becomes obvious. |
| more than a sevenfold increase in men under age 50 | | | | Furthermore, the treatments themselves have become |
| (from 1.3 to 9.4 per 100,000). | | | | less toxic. Big incisions have been replaced with |
| In an accompanying editorial, Otis W. Brawley, M.D., | | | | keyhole incisions, and, computers assist surgeons in the |
| chief medical officer of the American Cancer Society, | | | | most difficult steps - so called "robotic prostatectomy" |
| writes, "We desperately need the ability to predict | | | | or "da Vinci Prostatectomy." |
| which patient has a localized cancer that is going to | | | | Small incisions and computer assistance have reduced |
| metastasize and cause suffering and death and which | | | | the time in hospital and allowed men to return to work, |
| patient has a cancer that is destined to stay in the | | | | leisure and other activities in much shorter periods. |
| patient's prostate for the remainder of his life." | | | | Thus, technical and strategic innovations in both |
| Specialists in prostate cancer have recognised for a | | | | diagnosis and treatment have meant that the number |
| long time that they diagnose and treat more men with | | | | of men overtreated or suffering from the problems |
| prostate cancer than actually benefit and, at the same | | | | associated with treatment is probably much less than |
| time, many men with significant prostate cancer are | | | | before. |
| diagnosed too late. | | | | |