Much like breast cancer, there has been much controversy with prostate cancer “prevention” and treatment in recent years.
Mainstream medicine as well as the public health gurus all put all their bets on the PSA card when it came to prostate cancer “prevention.” (For those non-regular-readers of the Rantings, I always surrounding the word “prevention” in quotation marks because mainstream medicine does little to prevent cancers–most of what they call prevention is really early detection.)
The research over the past few years has been leading away from using PSA as an effective means of preventing prostate cancer and saving lives. Even the discoverer of the PSA test, Dr. Richard Albin, has clearly shown his opinion about the matter, stating that the test should never have been used for the early detection of prostate cancer.
The main concern with the widespread use of the PSA test to detect prostate cancer is that there are a large number of prostate cancers detected that never would progress to anything of substance. This large chunk of men diagnosed with non-aggressive prostate cancer is pushed towards surgery, radiation and chemotherapy for a cancer that would never create harm.
You can see the problem here.
One of the common treatments given to prostate cancer patients includes a drug to block the action of testosterone, referred to as androgen-deprivation therapy or ADT. The idea is, if we block the action of testosterone on prostate cells (regardless of where they may be in the body) they will not divide as rapidly and these patients should have a longer survival time.
But, like so much else in medicine, we take an idea that may sound good on the surface and run with it long before the research is done to confirm that it’s a good idea.
And sometimes this research takes a LONG time. In the case of hormone replacement therapy for women, HRT was used for almost 50 years before the research trials found out it was a bad idea. This was, of course, after the drug companies made billions of dollars on drugs like Premarin.
As a result, ADT therapy is a common drug approach used in men with prostate cancer, despite a list of side effects like weight gain, loss of sexual libido and heart disease. Which brings us to this particular study.
In it, researchers looked at 66,717 Medicare patients 66 years or older diagnosed with prostate cancer from 1992 through 2009. They were followed for 15 years (average follow up was 110 months) and broken out into high use and low use of ADT. Here’s what they found:
- ADT was not associated with improved 15-year survival following the diagnosis of localized prostate cancer.
- Among patients with moderately differentiated cancers (more serious types of tumors), the 15-year overall survival was 20.0% in areas with high ADT use vs 20.8% in areas with low use (in other words, it made no difference).
- The 15-year prostate cancer survival was 90.6% in both high- and low-use areas.
- In poorly differentiated cancers (the worst type), the 15-year cancer-specific survival was 78.6% in high-use areas vs 78.5%, in low-use areas.
- In this same group of poorly differentiated cancer, the overall risk of dying from any cause (not just cancer) over 15 years was 8.6% in high-use areas vs 9.2% in low-use areas (in other words, the group NOT using the ADT lived slightly longer).
Keep in mind that this is a very large study. While no single study sets anything in stone, the fact that we have been using an unproven therapy for prostate cancers that might never have progressed that have significant side effects should make you wonder just how many other commonly used treatments in medicine are creating far more harm than good.