Prostate Gland Health

– © Jeremy Laurance - 20 September 2004

The only available test for prostate cancer was last week declared “all but useless” by the Californian professor who developed it 17 years ago. The warning from Professor Thomas Stamey of Stanford University has left men wondering what they should do to protect themselves against the commonest form of male cancer. Professor Stamey’s work on the PSA test - for prostate-specific antigen, a protein that can indicate prostate cancer when found in high levels in the blood - has made it a standard worldwide. Now, he has recanted, and suggests that the test merely indicates the size of the prostate and may do more harm than good by encouraging over-treatment. Many of the cancers detected by it are too small to be clinically meaningful and many men may have been unnecessarily treated. “The PSA era is over,” he said in The Journal of Urology.

So how can men protect themselves from a disease that claims 10,000 lives a year?

Not all the men with a high PSA had prostate cancer. Even among those in whom it was confirmed by biopsy, "probably more than half" did not need treatment and the treatment carried serious risks, says Professor Cooper. “In the US they are making tens of thousands of men impotent for no reason. I hesitate to use the word ‘scandal’ but I can't think of a better word for it. It is beyond belief.”

In his view, only men with symptoms - difficulty peeing, a weak stream, or getting up in the night to pee - should have a PSA test. However, one in three men over 50 experience these symptoms anyway, which are often caused by benign enlargement of the prostate and not by cancer. Any man with a high PSA test must therefore be referred for a biopsy to confirm the presence of cancer.

Professor Cooper’s advice is that for those with “low-grade, low-volume” tumours in whom the PSA level is not too high, active surveillance may be the best option. The crucial task is to develop a better test for prostate cancer - one that can distinguish between the slow-growing, non-threatening tumours and the more aggressive kind.

Ed: This is an excerpt from a recent article on prostate health.