THE BATTLE AGAINST PROSTATE CANCER
"If the health-care industry would focus on preventive measures instead of potential cures, thousands of lives could be saved." WENDELL COVALT Redondo Beach, California
Thank you for your report on prostate cancer [MEDICINE, April 1]. Many think it is a disease of older men, but there has been a very rapid increase in prostate cancer in younger men. I was 48 when I asked for a diagnostic prostate-specific antigen test, even though my physician at the time did not recommend that I consider a PSA until I was 50. The tumor that was discovered was large and aggressive, but I am hopeful that my surgery was in time. Currently, researchers are looking mainly at older patients. We also need to focus more attention on the diagnosis and treatment of younger men. RICHARD SIGEL Alamo, California
You made note of a California physician's study concluding that external-beam radiation therapy cures only 20% to 25% of patients. But other studies show much better results. Several investigators around the country in very reputable radiation-oncology departments have shown that cure rates with external-beam radiation therapy are 40% to 60% of all patients and 80% to 90% of patients who are considered to be surgical candidates. The later cure rates are the same as those for patients who undergo radical prostatectomy, or excision of the prostate gland. We implore your readers to investigate all available treatment options through consultations with radiation oncologists as well as urologic surgeons. ALAN POLLACK, M.D. GUNAR K. ZAGARS, M.D. Department of Radiotherapy M.D. Anderson Cancer Center Houston
As a 42-year-old male who had a radical prostatectomy two years ago, I say shame on any health-care provider who feels that a PSA test can lead to widespread unnecessary treatment and withholds it from patients. Along with the view that there is no need to test in younger men, this attitude prevailed when my cancer was discovered. If I had not been an R.N. and a member of a hospital's administrative team, I might have gone untreated. It still took two years before an abnormal PSA and a rectal exam led to a correct diagnosis. I salute General Norman Schwarzkopf, Michael Milken and all the other high-profile men who have shared their stories with the world. I hope their efforts will lead to early detection and treatment for many men unaware they have prostate cancer. CLARK A. FENN East Longmeadow, Massachusetts Via E-mail
I speak against routine screening for prostate cancer. While our clinic regularly tests for many diseases, we don't systematically screen for prostate cancer. We do recognize that prostate cancer is a serious health problem and accept the PSA as an adequately sensitive test. However, we don't recommend screening because there is no evidence that detection or treatment of prostate cancer in asymptomatic men improves their lives or reduces their risk of dying from the disease. There is no way to differentiate the thousands of prostate cancers that will cause problems from the millions that won't. For the great majority of the 1 in 5 American men who develop prostate cancer, it will never have an effect on their lives. Most will die of other causes. Without a method of separating the destructive cancers from the insignificant cancers, we would be doing more harm than good. TODD SWANSON, M.D. Eau Claire, Wisconsin Via E-mail