No wonder men get confused about prostate cancer

A story about a 35-year-old male, newly diagnosed with prostate cancer, ran on a Houston television station yesterday. Let’s remember that Houston is the home of the M. D. Anderson Cancer Center and the Baylor College of Medicine, both of which are world-class prostate cancer centers. However, that didn’t stop people from getting half the facts wrong.

You can click here to watch the original video as played on the TV, or you can read the story. Here is a list of the faults we found in this story:

• The patient “found out he had cancer because he took a PSA test.” Can’t have happened. He’d have needed a biopsy to find out he had cancer. The PSA test was undoubtedly one reason why a biopsy was suggested, but there may have been others.

• Apparently, “the tests are getting better and young men are being diagnosed more often.” In fact, the PSA test most certainly is not “getting better,” and neither is the accuracy of a biopsy. There is also very little evidence that “young men are being diagnosed more often” than they have for about the past 10-15 years.

• According to Dr. Dov Kadmon, “We are beginning to diagnose it in the 40s and, again, that’s thanks to PSA.” Actually we have been diagnosing men in their 20s, 30s, and 40s for a while as a result of the availability of the PSA test. Whether all these men have clinically significant disease that needs treatment is a whole other question.

• “Prostate cancer is “now the No. 1 killer in our country more than heart disease.” What? I’m sorry. It’s not even close. The projected number of deaths from cardiovascular disease in 2010 is about 600,000 (more than all cancer deaths together and nearly 20 times the number of prostate cancer deaths)!

• Because he is only 35 and wants to retain his reproductive capabilities, the patient “said he’ll try to kill the cancer with different treatments” (by which he appears to mean something other than surgical removal of the entire prostate). The problem with that is that every established, curative therapy for prostate cancer (radical surgery, external beam radiation therapy, brachytherapy, cryotherapy, and even whole-gland, high-intensity focused ultrasound) is intended to remove or destroy all prostate tissue, thereby eliminating normal male reproductive function. It is possible that if he has focal therapy he might be able to retain reproductive function, but there was no mention of focal therapy in the story.

Let’s be clear … The patient in question is young; he will likely have good recovery from whatever therapy he decides to undergo; and we hope he does extremely well afterwards. However, …

• Someone needs to tell him he should be banking sperm.
• He needs a really good advisor to help him get the most appropriate form of therapy (depending on his personal data).
• He should then go back to the TV station in question and insist that they re-run his story to get the facts right.

If you wonder why most men have inaccurate and inappropriate perceptions about prostate cancer and its related risks and management, it is because of media stories like this! KHOU TV, Inc. in Houston should be able to do much better.