Monday, June 16, 2008

Should You Shrink Your Prostate?

Okay, bear with me here while I have a brief fantasy about being a urologist.

New York Times
reporter, Gina Kolata writes in "New Take on a Prostate Drug, and A New Debate" about the pros and cons of asymptomatic men taking a medication to decrease their chances of getting prostate cancer. She notes that screening tests reveal cancers (and therefore have surgery and other treatments) that might not prove to be lethal--- some prostate cancers are slow growing and might be better left undiscovered.

With finasteride, as many as 100,000 cases of prostate cancer a year could be prevented, said Dr. Eric Klein, director of the Center for Urologic Oncology at the Cleveland Clinic.

Dr. Howard Parnes, chief of the prostate cancer group at the National Cancer Institute’s division of cancer prevention, also is convinced. “There is a tremendous public health benefit for the use of this agent,” he said.

While it might seem convoluted to offer a drug to prevent the consequences of overtreatment, that is the situation in the country today, others say. Preventing the cancer can prevent treatments that can be debilitating, even if the cancers were never lethal to start with.

“That’s the bind we’re in right now,” said Dr. Christopher Logothetis, professor and chairman of genitourinary medical oncology at M.D. Anderson Cancer Center. “Most of the time, treatment wouldn’t help and may not be necessary. But the reality is that people are being operated on.”

Kolata goes on to talk about whether all men should take the medication as prostate cancer prophylaxis. She says an early study showed that while it shrunk prostates and decreased the rate of cancer diagnosis overall, among study participants there was a slight increase in the percentage of aggressive tumors found, and initially there was concern that the drug was causing aggressive tumors, rather than just unmasking them.

So why does this Shrink Rapper want to blog about prostates? As I read Gina
Kolata's article, I thought about ClinkShrink's post, An Ounce of Prevention where we talked about the theoretical option of treating people at risk for a psychiatric disorder who may never develop one. It seems we do this all the time-- how many people take Lipitor or other statins who might never develop coronary artery disease? How many people with osteoporosis are given medications who might never break a bone without it, who might break bones even with them? Oh, and if you're male, and therefore at risk for Prostate Cancer, now there's something else to think about. There is, after all, iodine in our salt and fluoride in our water. Maybe it's not all bad?