Over-Diagnosing Prostate Cancer?

Over-Diagnosing Prostate Cancer?

HANOVER, N.H. (Ivanhoe Broadcast News) -- Each year, more than 230,000 men are diagnosed with prostate cancer in America. The disease will kill about 30,000 of them. Some researchers, however, are beginning to question whether we need to do as many prostate screenings as we do.

H. Gilbert Welch, M.D., an internist at VA Hospital/Dartmouth Medical School in Hanover, N.H., says, "The harder we look for cancer, the more pseudo-disease we find." Pseudo-disease is cancer that won't harm you if left untreated, according to Dartmouth Dr. Gil Welch. "We assume they're all bad, and we tend to treat people."

The treatment leaves some men with unnecessary side effects -- like impotence and incontinence. Dr. Welch, who literally wrote the book on screening, questions just how useful it is. "What we should be doing is tell people the whole story and let different people come to different decisions," he tells Ivanhoe.

The increase in prostate cancers diagnosed from 1973 to 2000 occurred when PSA screenings hit the scene. While the number of men diagnosed with prostate cancer has dramatically increased, the number of deaths over the same time has not. Dr. Welch says, "When everyone sees the pattern of the dramatic rise in incidence with no concomitant change in mortality, one has to worry that there's been an over-diagnosis."

Of course, Dr. Welch does have opposition.

Gary Onik, M.D., a radiologist at Florida Hospital Celebration Health, says, "That's kind of tunnel thinking, you know. Let's not diagnose it because the treatments are bad." Dr. Onik does acknowledge over-diagnosis happens but worries what would happen if screenings stopped.

"There are some that are very aggressive and you find those early, I think you will definitely be saving lives," Dr. Onik says. The problem is knowing which cancers are slow-growing and which will kill. There is still no readily available test to do that.

Dr. Welch says he only questions screenings in men with no symptoms for prostate cancer. For men who have symptoms of the disease, he strongly supports screenings.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/