My wife Wendy and I wrote the following as a response to a Father’s Day article in the New York Times.
Gina Kolata published a front page article in today’s (Sunday, 15 June 2008) New York Times entitled “New Take on a Prostate Drug, and a New Debate.” The article is about the use of finasteride as a preventive for prostate cancer.
A new look at a federal study shows that the prophylactic use of finasteride may reduce the incidence of prostate cancer by as much as 30%! As with other drugs used preventively, the debate refers to the use by healthy people of lifelong medications to avoid getting and being treated for a disease, in this case, prostate cancer. At this point, the potential long term side effects are unknown.
Her news is exciting and the article compelling. Unfortunately, Ms. Kolata has fallen into the sad, but very common trap of characterizing prostate cancer as “a cancer that, most often, would be better off undiscovered and untreated.” She wrote, “Prostate cancer is unlike any other cancer because it is relatively slow-growing and while it can kill, it often is not lethal. In fact, most leading specialists say, a major problem is that men are getting screened, discovering they have cancers that may or may not be dangerous, and opt for treatments that can leave them impotent and incontinent.” She either neglected to write or just missed this stark truth: in the United States alone, 28,000 men will die this year from prostate cancer! In our view, 28,000 deaths in one year from one disease is not the description of an indolent disease. The key in her statement is the mention she made, but then ignored, that some prostate cancer is dangerous. While there are statistical models, at this point, there is no way to determine definitively which cancers will eventually be lethal.
There are legitimate concerns regarding screening and treating. The issue mentioned by Ms. Kolata about over screening for prostate cancer should not be one focusing on should we screen, but instead should focus on what we do with the information we gather from screening, and how decisions to treat are ultimately made. As we in the United States have increased screening, our death rate from prostate cancer has declined; this is not the case in countries that do not screen as rigorously. This does not mean that all men diagnosed via this screening will require immediate invasive treatments, but all men with positive screenings should be followed. Many men, when told they have prostate cancer, respond initially with sheer panic. In their rush to address cancer, doctors and patients may miss the extent of harm done by possibly unnecessary treatments, and may miss some alternatives. For some men, the treatment modality called watchful waiting or active surveillance is appropriate: it involves constant and aggressive monitoring of the disease as well as making significant lifestyle changes with the hope of inhibiting the cancer. Then, if the disease progresses, a man could decide to move ahead and opt for a more aggressive treatment.
We hope that finasteride will be a good alternative for men with risk factors for prostate cancer, and are grateful for something good in the armament against this disease, something that may protect our sons from a disease that can be, in some men of all ages, aggressive and lethal. It is a mistake to characterize prostate cancer only as “a cancer that, most often, would be better off undiscovered and untreated.” On this Father’s Day, just ask the families of the 28,000 men in the US who will not survive it this year.
Joel T. Nowak, M.A., M.S.W.
Wendy A. Lebowitz, Ph.D., M.P.H.
Sr. Psychologist, Interfaith Medical Center