Magazine article Insight on the News

Doctors Continue to Differ Widely on Treatment for Prostate Cancer

Magazine article Insight on the News

Doctors Continue to Differ Widely on Treatment for Prostate Cancer

Article excerpt

Growing older isn't a disease, but it brings disease with it. For men, aging raises the specter of prostate cancer. Researchers are learning more about the perplexing illness, but they have yet to find a cure.

Prostate cancer is the most common type of cancer in men (exclusive of skin cancer) and the second leading cause of cancer death (after lung cancer). While the malignancy usually afflicts men in their 70s, it can strike some younger than 55. When it is aggressive.

Indeed, a new case of prostate cancer is diagnosed every three minutes in the United States. Unfortunately, because the disease can be asymptomatic, it often is diagnosed too late: The cancer already has spread throughout the body. In 1994, for example, the cancer had spread beyond the prostate gland in two-thirds of the cases diagnosed.

This year, an estimated 317,000 men -- about 70,000 more than the annual average earlier in the decade -- will be found to have the disease, and 48,000 will die from it. By the year 2000, the incidence is expected to increase a whopping 90 percent, with prostate-cancer deaths predicted to increase 37 percent.

Ironically, the organ that is the cause of such devastating illness is no larger than a chestnut. The prostate is a muscular gland critical to reproduction, producing the seminal fluid that carries sperm cells. It owes most of its growth to testosterone and other male sex hormones.

Cancer by no means is the only disease that strikes the prostate. An even more ubiquitous condition, benign prostatic hyperplasia, or BPH, an enlargement of the prostate gland, afflicts two-thirds of all men sometime in their lives. Because it presses on the urinary tract, an enlarged prostate can cause irritation and obstruct the flow of urine. And as the leading cause of surgery for men over 55, BPH is a very expensive disease, carrying a price tag of $3 billion a year. (Despite its name, BPH not always is benign: In severe cases, it can lead to death.)

There is yet a third disease -- actually a family of diseases -- that bedevils men. Prostatitis can be acute and short-term or chronic. It may be bacterial or not. Of the three categories, however, prostatitis is the most easily treated, generally with antibiotics or other medication.

The good news is that while all prostate cancers appear to begin alike, they do not inevitably lead to death. Prostate cancer often can be indolent, causing no symptoms and never spreading. Autopsy studies show that 30 percent of men have prostate cancer when they die, although most never know it. Something else to bear in mind: If caught early enough, prostate cancer is curable.

Nor is everyone equally susceptible to the disease. African-American men have an especially high risk of developing prostate cancer and of dying from it -- about 35 percent higher than that of Caucasians and twice as high as that for Hispanic or Asian men. In the United States, the incidence of prostate cancer is 70 times as high among American blacks and 37 times as high among American whites as it is in China; in Japan, the death rate from prostate cancer is less than a quarter of the American rate.

Why are Americans experiencing a surge in prostate-cancer cases? Some experts raise the specter of an epidemic, citing environmental or dietary factors. Other analysts maintain that in fact, despite the increase in diagnosed cases, there is no rise in fact.

"There's no epidemic -- but the older the population of men the more incidence there will be," Patrick Walsh, a noted urologist at Johns Hopkins University School of Medicine in Baltimore, tells Insight. More accurate screening is picking up cases that previously might have escaped notice, he points out. Walsh also suggests that as baby boomers (born between 1945 and 1960) grow older, the average age of men undergoing diagnosis will drop by a decade (when the disease is curable). …

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