How Improvements in Treatment Have Reduced Problems Associated With Treatment

The report, in the September 2009 edition of the Journal of the National Cancer Institute estimates 1.3 million additional men have been diagnosed and treated for prostate cancer since 1987. Authors claim most of this group are likely to have been overdiagnosed.

"Given the considerable time that has passed since PSA screening began, most of this excess incidence must represent overdiagnosis," the authors write. "All overdiagnosed patients are needlessly exposed to the hassle factors of obtaining treatment, the financial implications of the diagnosis, and the anxieties associated with becoming a cancer patient..."

The increased diagnosis has been most dramatic among younger men: more than tripling since 1986 in men aged 50-59 (from 58.4 to 212.7 per 100, 000) and more than a sevenfold increase in men under age 50 (from 1.3 to 9.4 per 100,000).

In an accompanying editorial, Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, writes, "We desperately need the ability to predict which patient has a localized cancer that is going to metastasize and cause suffering and death and which patient has a cancer that is destined to stay in the patient's prostate for the remainder of his life."

Specialists in prostate cancer have recognised for a long time that they diagnose and treat more men with prostate cancer than actually benefit and, at the same time, many men with significant prostate cancer are diagnosed too late.

Almost 10,000 men die from prostate cancer in the UK each year, having received either inadequate treatment or were beyond curative intervention at the time of diagnosis. Furthermore, a massive European study has shown that testing a man's PSA can reduce the chance of dying from prostate cancer by around 20 per cent or more.

So what strategies should we follow? As it turns out, more specialists try to direct men with prostate cancer to active monitoring, which is intense observation, when there is enough doubt that surgery or radiotherapy is needed.

This tactic avoids "overtreatment" but hopefully keeps the window still open for successful surgery or radiotherapy if the need becomes obvious. Furthermore, the treatments themselves have become less toxic.

Big incisions have been replaced with keyhole incisions, and, computers assist surgeons in the most difficult steps - so called "robotic prostatectomy" or "da Vinci Prostatectomy."

Small incisions and computer assistance have reduced the time in hospital and allowed men to return to work, leisure and other activities in much shorter periods.

Thus, technical and strategic innovations in both diagnosis and treatment have meant that the number of men overtreated or suffering from the problems associated with treatment is probably much less than before.

Marc Laniado is a Consultant Urologist at Harley Street Urology who are UK experts is prostate cancer testing and treatments.

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