Diagnosed with prostate cancer?
Submitted by Dr.Kattlove’s Cancer Blog
What an enigma. Perhaps the best argument against intelligent design is a man’s prostate gland. It hardly serves any useful function. And it is likely to become cancerous (nearly half of elderly men have cancer in their prostate gland at autopsy). And treating the cancer often causes impotence and incontinence.
I’m 70 years old and get my PSA done yearly. It tends to hover in the 4-6 range (anything above 4 is considered suggestive of cancer) and when it hit 6 a couple of years ago, I had a biopsy (not a fun experience but not as bad as I anticipated). Fortunately, no cancer.
Before the result came in, I spent hours pondering my treatment if I had cancer. I could choose surgery or radiation or no treatment. The last choice would let me avoid the likely side effects of impotence and incontinence caused by either radiation or surgery. But what were the risks of no treatment?
Now I think I know the right answer. A recent article, in the May 15 issue of the New England Journal of Medicine, described a 56 year old man whose PSA rose to 6. The biopsy showed a low grade cancer (Gleason score 6 – Gleason scores range from 6-10 and are a way the pathologist who examines the biopsy tells how serious the cancer is - 6 is slow growing and 10 is fast growing). The man chose surgery, but at the last moment pulled out and decided on the no treatment option. 10 years later his PSA hasn’t budged and he is fine. So why did he do so well?
In 2006 British researchers published their calculations on how likely prostate cancer was to kill a man who wasn’t treated. Using published data and some complicated math, they figured that for this 56 year old guy, the chance of dying from prostate cancer in 15 years without treatment and with a Gleason 6 cancer was 0. A Gleason 6 seems like a kind of benign “cancer”. If the Gleason were 7, then his chances of dying of prostate cancer in 15 years without treatment would be 31 percent and if the Gleason score were higher, it would be 72 percent. Because he had a low Gleason score, he did well. If it had been higher, avoiding treatment, which would have cut his chance of dying from the cancer nearly in half, would have been a big mistake.
How about for us elderly? Same thing. The chance of a Gleason 6 prostate cancer killing a 70-year old man in 15 years without treatment is 2 percent. At Gleason 7, the chances of dying from prostate cancer would be 9 percent and if it were greater than 7, it would be 28 percent. Treatment would cut these numbers in half. Why are the chances of dying of prostate cancer so low? Because something else might deal the fatal blow. According to U.S. Social Security life expectance tables, life expectancy at 70 is only 13 years. You can add 6 years to this if someone is in tip-top shape and cut it in half if there are serious problems.
Still, these numbers are only rough calculations and not the final answer. The good news is that there are two ongoing studies comparing treatment with surgery or radiation against no treatment. These will be much more definitive than the British report about what to do if you are diagnosed with prostate cancer. Unfortunately, because it takes so long for prostate cancer to cause trouble, we will need to wait several more years till the results of these studies come in.
The bottom line for now is that low-grade cancers in older men probably don’t need to be treated. But once the Gleason gets above 7, then we elderly are taking chances by avoiding treatment, especially if we are in great shape and expect to live longer than average.
