Most Prostate Removals Unnecessary, Expert Says Doctors could be removing far too many prostates and wasting millions of dollars on unnecessary prostate surgery due to a fundamental misunderstanding of a key lab value, according to one of the world's leading authorities on prostate cancer. Dr. Thomas Stamey of California's Stanford University said only 2 percent of prostates removed at Stanford over the past five years had, upon examination, cancer large enough to warrant removal; 98 percent of those removed did not need to come out, Stamey and his team found. If they are right, that could mean 191,100 unnecessary prostate surgeries each year in the United States. At a cost of thousands of dollars each, that translates to hundreds of millions of misspent dollars. Prostate removal is a major operation that leaves about 3 percent or more of men incontinent, and at least half with sexual difficulties that can include impotence. The problem is that urologists at Stanford and elsewhere have thought mildly elevated blood levels of an enzyme called prostate specific antigen, or PSA, correlated to cancer severity. Instead, Stamey, who pioneered the use of PSA to diagnose prostate cancer in the 1980s, has concluded that mildly elevated PSA - values between 2 and 10 - are almost always related to normal enlargement of the organ as men age, not cancer. Almost all men develop prostate cancer if they live long enough. Eight percent of men in their 20s, one study found, had the disease; 80 percent in their 70s. But it is often such a slow- growing cancer that it does not significantly elevate PSA and rarely causes problems. Many men never realize they have it. Prostate cancer kills 226 out of 100,000 U.S. men over the age of 65, an "extraordinarily low death rate," said the Stanford urologist. The prostate is a walnut-sized gland at the base of the male pelvis. PSA is secreted by the organ to thin the ejaculate that carries sperm, but escapes into the blood when prostate cells are damaged. A Hard Choice What the Stanford team is saying is not without controversy. Medicine, like other sciences, is advanced when bold ideas are put forward to be assessed and either accepted or rejected by the medical community. What makes Stamey's bold idea significant is his stature as a leader in the field of prostate cancer treatment and the fact that his findings are based on new observations, not reinterpretations of old findings. What he and his team think often happens is that a mildly elevated PSA leads to a biopsy to check for cancer. The biopsy is almost always positive because the cancer is so common. That leads to surgery to remove the prostate, even though most of the prostates they studied in the past five years did not warrant removal. "When we get them out, they're such small cancers that they would not bother a man who lives to the age of Methuselah," Stamey said. But there is no certain way at present to tell which one of those tiny cancers will progress, said Tacoma urologist Dr. William Dean. If doctors wait until it is obvious that the cancer it dangerous, it is usually too late for a cure. Physicians - and patients - are left with a terrible decision: Perform a serious operation that might not be necessary, or wait and risk the small chance that the cancer will turn deadly. Mindful of litigation and wanting to prevent the worst, doctors often err on the side of caution. "These guys are not going to be happy finding they have metastatic disease down the line from watchful waiting," Dean said. "It's not a wrong decision to have the operation." What is needed is a blood test that relates to the size of the tumor, said Stamey. Three Ph.D. scientists in his lab do little else but search for just such a marker, but so far have found little success. Until one is found, Dean and other urologists believe that even small rises in PSA remain a useful diagnostic tool for serious cancer, especially by looking at how fast PSA rises and similar calculations. "No one disagrees that PSA is not the perfect tool," he said, "but it's the best we have." Annual exams needed Stamey believes a mistake over the importance of small rises in PSA arose because in the 1980s, when he helped popularize PSA use, prostate cancer was usually caught later than it is now, and advanced disease really does elevate PSA to high levels. That led to the assumption that small rises are also significant, an assumption the Stanford urologist said caused him and others to remove prostates that might not have needed to come out. He thinks now the best thing for men to do is to have an annual rectal exam, though even that technique can miss some large cancers. If the prostate has a hard area, it should be biopsied and removed if found cancerous, he said. For doctors, his key message is that PSA elevations between two and 10 are not caused by cancer but by the normal age-related prostate enlargement, called benign prostatic hypertrophy. Stamey still also recommends annual PSA blood tests. Above 10, a biopsy is always warranted, he said. The Stanford team's findings appeared in the October issue of the Journal of Urology. Source: The News Tribune Tacoma, WA, 12/04 Thanks to cancercompass.com Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.