BUYER BEWARE

BY RALPH BLUM

According to Thomas Stamey, MD, a leading expert on prostate cancer and the man who developed the PSA test, “When the final chapter of this disease is written, it will prove that never in the history of oncology will so many men have been so over-treated for one disease.”

Why is this? One reason is financial. As a seasoned observer of the multi-billion dollar prostate cancer industry told me, “Your prostate is worth what Ted Turner would call ‘serious cash money.’” In a time of spiraling healthcare costs it is worth noting that biopsies alone have become a billion dollar a year business, and far too many of them are performed on men in their 70s and 80s with disease that would never become clinically significant in their lifetimes. But a positive biopsy puts them immediately at risk for serious infections and unnecessary radical treatment. Why? Because both doctors and patients over-react to the information the biopsy test supplies.

Although prostate cancer is typically a non-life-threatening disease, most men find it hard to believe that any kind of cancer can remain dormant for years. So they are highly motivated to get rid of it, and the quick fix of surgery seems like the most attractive option. Furthermore the urologist who performs the biopsy is a surgeon so that, providing the cancer is still contained in the gland, it is natural that his treatment of choice would be surgery.

Another reason so many men rush into surgery without, apparently, taking into account that even the most talented surgeon cannot promise a cure, let alone know if he can save the nerve bundles that control erections, is all the marketing hype surrounding robotic surgery.  So far there has been no proof that robotic surgery has better results than a regular prostatectomy when both are performed by equally skilled surgeons, but many men are lured by the glamor of “the robot that can operate.” As Paul Levy, former head of Beth Israel Deaconess Medical Center in Boston, once said, “The easiest population to market in this country is the group of men worrying about the functioning of their penis.”

The psychological impact of a cancer diagnosis is overwhelming, and the emotional appeal of “cutting it out” drives far too many frightened and vulnerable men toward surgery although, in many cases, no immediate treatment is necessary. According to Stamey, prostate cancer is a disease all men get if they live long enough. “Our job now,” he said, “is to stop removing every man’s prostate who has prostate cancer. We originally thought we were doing the right thing, but we are now figuring out how we went wrong. Some men need prostate treatment but certainly not all of them."

So in what Stamey calls “this heavily screened country,” it is up to each of us to take the time to do some research and not let either fear or marketing hype dictate our treatment decisions.