Prostate Cancer Diagnosis May Bring Suicide, Heart Risks

Hadler said he advocates diagnostic screening -- screening in response to a symptom the patient notices -- rather than general screening, "which is a response to a date on the calendar."

"The data suggests that we don't have to do screening, with mammography or PSA, to increase the likelihood of saving lives," he said, although he added that risks for incontinence and impotence following prostatectomy are better reasons than those listed in this study to reconsider screening.

But while prostate cancer screening guidelines recommend patients speak with their doctors about the risks and benefits of prostate cancer screening, in practice, primary care physicians do not have the time to have those conversations with their patients.

For that reason, Brawley said, he has asked staffers at the American Cancer Society to create a pamphlet to explain the risks and benefits to patients, since he realizes the problem of time, and said it may be better spent.

"I'd rather him talk about them not smoking and talk about them not gaining weight," he said.

But screening will present a problem as long as doctors cannot tell whether a tumor will kill a patient or whether it will grow so slowly that the patient will die of something else, and so treatment is unnecessary.

In the end, Brawley said, it isn't that screening is ineffective, but that it is not the magic bullet that it has been made out to be in saving lives.

"In many cancers, we have overly hyped screening," Brawley said. "It doesn't mean that screening is not beneficial; it means we promised more that screening cannot provide."

Ultimately, Hadler said, screening requires an answer to the question of how deadly the prostate cancer that may be found is in the first place, but doctors do not have that answer yet.

"Do I have a prostate cancer that I will die with, or do I have a prostate cancer that I will die from, and do we have a test available that will distinguish between the two possibilities?" he said.

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