LETTER
Prostate Cancer: Emerging Concepts
Timothy J. Wilt, MD, MPH
15 December 1996 | Volume 125 Issue 12 | Pages 1014-1015
TO THE EDITOR:
The Update by Garnick and Fair [1] selectively emphasizes data from uncontrolled reports to suggest that screening and aggressive treatment of prostate cancer are beneficial, but it ignores or dismisses the preponderance of evidence showing that early detection and intervention are not of proven benefit. The American Urological Association Treatment Guidelines Panel [2] and the U.S. Preventive Services Task Force [3] have published evidence-based reviews on early prostate cancer detection and treatment that do not support the strategies advocated by Garnick and Fair.
The American Urological Association Panel found the data to be inadequate for valid comparisons of treatments and recommended that all men with early-stage prostate cancer be informed of such treatment options as radical prostatectomy, radiation therapy, and watchful waiting. The Panel stated that it "considered these interventions to be options because data from the literature do not provide clear-cut evidence for the superiority of any one treatment" [3]. The U.S. Preventive Services Task Force and the Clinical Evaluation Task Force of the American College of Physicians have recommended against prostate cancer screening primarily because neither early detection nor intervention has been shown to increase duration of survival or improve quality of life in any group of men. Strategies of prostate-specific antigen testing and intervention similar to those proposed by Garnick and Fair are not cost-effective under most reasonable assumptions [4, 5]. Such strategies would probably result in prohibitive expense even if early detection and intervention were eventually determined to be of clinical benefit.
The effectiveness of early detection and treatment of prostate cancer can only be resolved by completion of ongoing randomized trials. Until these trials are completed, men with prostate cancer, their families, and their physicians would be better served by Updates that emphasize that the principal "emerging concept" in prostate cancer remains the unproven effectiveness of early detection and treatment.
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Author and Article Information
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Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417.
1. Garnick MB, Fair WR. Prostate cancer: emerging concepts. Part I. Ann Intern Med. 1996; 125:118-25.
2. Middleton RG, Thompson IM, Austenfeld MS, Cooner WH, Correa RJ, Gibbons RP. Prostate cancer clinical guidelines panel summary report on the management of clinically localized prostate cancer. J Urol. 1995; 154:2144-8.
3. Screening for prostate cancer. In: U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2d ed. Baltimore: Williams & Wilkins; 1996:119-34.
4. Cantor SB, Spann SJ, Volk RJ, Cardenas MP, Warren MM. Prostate cancer screening: a decision analysis. J Fam Pract. 1995; 41:33-41.
5. Barry MJ, Fleming C, Coley CM, Wasson JH, Fahs MC, Oesterling JE. Should Medicare provide reimbursement for prostate-specific antigen testing for early detection of prostate cancer? Part IV: Estimating the risks and benefits of an early detection program. Urology. 1995; 46:445-61.
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