Prostate cancer is the most common cancer among men, but medicine is at a loss to know how to treat it. Two recent studies reveal that screening can actually do more harm than good, and the increasing use of surgery has yet to be proven.

Medicine has adopted a two pronged attack on the condition, which, of all the cancers, is now the second major killer, usually among older men. The first stage is a screening programme for the over 50s in an attempt to detect the cancer at an early stage. The second, once the cancer has developed, is surgery either radiation or radical prostatectomy which has increased five fold between 1984 and 1990; in real terms, surgical intervention has increased 10 times more than have actual cases of the cancer.

But neither approach is working. There is no evidence to suggest that men given a prostatectomy will survive any longer than those left alone, especially if they are within 10 to 15 years of the average age of death. In addition, side effects of the operation can be serious, including impotence in 34 per cent of cases and incontinence, point out American researchers Syed Bilgrami and Bernard Greenberg, from two hospitals in Connecticut, writing in The Lancet (10 September 1994).

The three screening techniques for prostate cancer, prostate specific antigen (PSA) , transrectal ultrasound (TRUS) and digital rectal examination (DRE) are also ineffective, according to a new analysis by the Toronto Hospital in Ontario, Canada. The study, headed by Murray Krahn, concludes that screening can do more harm than good, partly because of the numbers who go on to have surgery and its high risks of permanent side effects.

!AJAMA, 14 September 1994.

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Written by What Doctors Don't Tell You

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