Book challenges the 'pro-testing' movement for prostate cancer
16 November 2010
Men need to weigh up the significant risks as well as the benefits associated with being tested for prostate cancer, according to a new book from the University of Sydney.
Let sleeping dogs lie? What men should know before getting tested for prostate cancer is being launched on Thursday 18 November and was co-authored by the University of Sydney's Professor Simon Chapman, Associate Professor Alex Barratt and Associate Professor Martin Stockler.
The aim of the book is to provide a detailed examination of the main questions that a man should be asking before deciding to get tested for prostate cancer. It is designed to help men to make more informed decisions.
"In writing the book, we aimed to provide much needed balance to what is often an irresponsible, one-sided pro-screening message," Professor Simon Chapman said.
"We wanted to make men more informed before they take a step that could dramatically and irreversibly change their lives. There are many men who have not been tested, who have taken this decision very consciously: they are not just avoiding it or 'burying their heads in the sand'. They have decided that the risk to benefit ratio means the risks are too high.
"Medical science is today unable to predict with any precision which early discovered prostate cancers will turn out to be those that kill, and particularly which will kill men in middle age. The frontline diagnostic tool in efforts to screen for prostate cancer, the PSA test, is a tool which has very poor ability to find problematic cancers. It finds many benign cancers which could have been left alone.
"Deciding to have a PSA test can quickly lead to a course of events that for some men may save their life. But for many more a test will result in serious, unnecessary surgery and other interventions. In a large proportion of cases, this will cause enduring and often permanent, major after-effects in the form of sexual impotence, urinary incontinence and less commonly, faecal incontinence.
"Many men who get tested will thus be found to have high PSA levels. Many will be then biopsied and counselled to have their prostates removed. This will stop them dying from prostate cancer, but the autopsy studies tell us that many of these men would not have died of prostate cancer even if their cancers had never been found. The problem is that there is no reliable way of knowing the benign from the deadly cancers, so overtreatment is rampant."
Professor Chapman said prostate cancer is a disease that far more men die with rather than from.
"We know this thanks to many autopsy studies where men who die suddenly are examined for cause of death. At autopsy, 10 to 20 percent of men in their 50s and 40 to 50 percent in their 70s have prostate cancer but died from other causes.
"Prostate cancer tends to kill far later in life than other cancers. The average age of death for prostate cancer in Australia is 79.8 years, while the average age for all male cancers combined other than prostate cancer combined is 71.5 - considerably younger.
"It is important to note that no government anywhere in the world has introduced a prostate cancer screening program."
Let sleeping dogs lie? is available for $25 or free download from the Sydney University Press website.
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