The American Cancer Society has released its revised statistical projections for prostate cancer diagnoses and deaths in the United States for the upcoming year of 2008. The projection calls for 186,320 men to be diagnosed and 28,660 to die from the disease. These numbers do not take into account the many men who die from other issues such as coronary failure, which was prompted by prostate cancer.

This is the first time in many years that the ACS forecasts include an increase in the number of deaths and at the same time, it projects a small decrease in the number of men who will be diagnosed. In 2007 the forecasted number of deaths was 27,050 (as opposed to 2008 with a projection of 28,660) and newly diagnosed was 218,890 ( as opposed to 186,320 in 2008). The differences are a 6% increase in deaths and a 14.8% decrease in diagnosis!

There has been a recent and insidious underlying campaign in recent years to discourage wide spread screening of men for prostate cancer. Could these new projections be a result of this campaign’s success? If this is the case then we can look forward to constant increases in the number of us who will die from prostate cancer.

The other new twist we have to recognize is the American Cancer Society’s has adapted a new direction about prostate cancer screening. It was pointed out in a posting from Skip Lockwood (President and COO of the National prostate Cancer Coalition) on the ProstatCancerSupport listserv that a recent article in this month’s AACR magazine—CR entitled “A New Directionfor the American Cancer Society” (Volume No.2, Issue 4, Fall 2007) indicates that the American Cancer Society (ACS) is probably going to take a new direction in their support for prostate cancer screening. Dr. Otis Brawley says that the Society will change its focus and work on issues of health disparities and insurance coverage.

Dr. Brawley has been very outspoken about his doubts that PSA testing and screening actually improves prostate cancer survival. The same article also included comments from “an advocate”, two-time breast cancer survivor, Jane Permutter who comments that she was pleased to hear that the Society finally hired someone with skepticism about screening. She went on to talk about screening and said “I think there is actually some harm to it.”

Skip also said that the National Prostate Cancer Coalition has been struck by the number of men who that use the Coalition’s “Drive Against Prostate Cancer” as their first medical intervention. He went on to say, “ Screening for prostate cancer does not occur in a vacuum. Many very real urologic issues are discovered in the course of the screening and for many men this is their first entrance into the medical system. Otherwise, they continue to suffer with many conditions until those conditions become life threatening or completely untenable and the most expensive choice possible. It is awfully hard to get people access to care when they don’t or won’t access it. The dysfunctions of the health care system are many and varied and I am fearful that the “pick a point and make a stand here” method fails to acknowledge the fundamental interconnectedness of everything.”

I am very sad to hear that the American Cancer Association has joined the bandwagon against prostate cancer screening. The problem is not that we are identifying cancers that don’t require treatment, but it is that many urologists when diagnosing prostate cancer to quickly rush their patients to treatment. Good medicine involves appropriate recommendations for proper treatment. Watchful waiting is an appropriate treatment modality, but we know it doesn’t generate billable hours and can also can open a physician to a potential malpractice suite if the cancer progresses.

Therefore, the issues are that docs are looking to generate dollars and our legal system requires an over reaction to test results. These items are the ones needing fixing, not less screening.

Joel T Nowak MA, MSW