In 2004, prostate cancer killed 2761 Australian men. So what are we to make of two statements this week from people who ought to know better?
First, that “every single hour at least one man dies of prostate cancer” (Professor John Shine, head of Sydney’s Garvan Institute, in a fund-raising letter send to thousands of potential donors), and second, that “prostate cancer is second only to heart disease” in killing Australian men (Dr Andrew Rochford Channel 7 What’s Good for You, 5 June).
Both statements are outrageously incorrect. If prostate cancer killed one man an hour there would be 8760 deaths from the disease each year — only a 317% exaggeration. And prostate cancer is not “second only to heart disease” as a cause of death either. It’s the 6th leading cause death in men (see Table 2.19), a long way behind ischemic heart disease which kills 13,152 men a year; stroke (4826); lung cancer (4733); other heart disease (3290); and chronic obstructive pulmonary disease (2986).
Moreover, prostate cancer tends to kill men late in life (when death per se increases — and we all have to die of something). Ischemic heart disease causes the loss of 151,107 DALYS (Disability Adjusted Life Years), compared with 36,546 lost to prostate cancer, putting it in ninth place.
While some Australian urologists are out on the hustings talking up the importance of prostate-cancer screening, few Australians would be aware that only one cancer agency of any international significance (the American Cancer Society) recommends prostate-cancer screening.
The International Union Against Cancer states “there is no evidence” that population-based screening for prostate cancer reduces mortality rates, joining the US Preventive Services Task Force, and the UK’s National Australian Prostate Cancer Collaboration nor any cancer council.
You would know none of this from any casual observation of media coverage of the disease where men are repeatedly told they are not “being a man” if they don’t get tested.
Screening asymptomatic men for prostate cancer results in large numbers being subsequently invasively investigated and undergoing major surgery, when the benefits of this in preventing men dying /from/ prostate cancer (rather than dying /with/ it, but from another cause) remain unproven.
A 2002 review in the Lancet concluded that if 1 million men over 50 were screened, “about 110,000 with raised PSAs will face anxiety of possible cancer, about 90,000 will undergo biopsy, and 20,000 will be diagnosed with cancer. If 10,000 of these men underwent surgery, about 10 would die of the operation, 300 will develop severe urinary incontinence and even in the best hands 4000 will become impotent.” And then came the crunch: “The number of men whose prostate cancer would have impinged on their lives is unknown.”
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