Prostate Cancer Prevention Controversy
By William Faloon
My editorial in the May 2013 issue of this publication generated quite a bit of feedback and critique.
Some Life Extension® members said it should be a mandatory part of physician education. Others raised concerns about the use of the PSA blood test as a screening tool, why I suggest Avodart® for certain men, and why drugs were mentioned since there are nutrients that function via similar mechanisms.
The most impressive critique came from Patrick C. Walsh, MD, who may be the most renowned prostate cancer expert in the world. Dr. Walsh was involved in identifying the genetic characteristic of hereditary prostate cancer and pioneered “nerve-sparing” surgery. I have urged hundreds of prostate cancer patients to travel to Johns Hopkins to have Patrick Walsh perform their surgery, as I consider him the finest in the world.
So when Dr. Walsh writes us, I pay attention, and Life Extension members should be informed that there are credentialed individuals that are against using drugs in the class of Avodart® for cancer prevention purposes.
Shortly after my editorial was published, the American Urological Association issued revised guidelines for PSA screening. They now say PSA screening should be mostly considered only for men aged 55-69.1 We vehemently disagree with this new recommendation and chastise this group for not emphasizing the need to devise safer and more efficient ways of performing prostate diagnostics.
To emphasize the seriousness of all this, the chart on this page shows the spiraling incidence of prostate cancer that occurs as men age. Autopsy results reveal that 85% of men have atypical cells in their prostate glands and 1 in 4 has cancer.2 While many men with atypical lesions or even malignant cells in their prostate do not ever progress to clinical disease, aging men cannot ignore this problem.
The public still accepts absurdly short life spans. We at Life Extension do not and that is just one reason why our position on prostate cancer differs from the mainstream.
There is something to be said about attending live lectures as opposed to staying glued to our computer/TV screens. A good speaker can make an impact that you may forever remember.
I’ll never forget a lecture I attended in 1977 at a South Florida condominium social hall. The place was packed with retirees. The lecturer was over age 80 and passionately urged all men to visit a urologist once a year for a digital rectal exam. He began by reading a long list of the names of the many members of his retirement community who had suffered agonizing deaths from metastatic prostate cancer.
The lecturer understood that a digital rectal exam would not detect all prostate cancers, but he knew it could save lives. If the PSA blood test had been available at that time, I can only imagine how feverish this benevolent speaker would have been in advocating PSA tests to his fellow men.
Move forward 35 years and the federal government and some mainstream medical groups are recommending against PSA screening, which is more reliable than digital rectal exams, though both ideally should be done annually.1,3
What Makes Prostate Cancer Different?
Prostate cancer is unusual in that it has a blood marker called prostate-specific antigen (PSA) that can facilitate early detection, thereby enabling therapies to be employed before cancer spreads to regional lymph nodes or distant metastases occur.4
With the advent and widespread use of PSA screening, an argument can be made based on a large human study that huge numbers of men could be spared agonizing deaths from metastatic prostate cancer.5,6 The earlier diagnosis of prostate cancer, however, must be put into context of the individual patient to ascertain which men need to be treated and which men are reasonable candidates for active surveillance or “watchful waiting.”
The journal European Urology published a study in 2013 conducted on nearly 35,000 men aged 55-69.5 This data came from the European Randomized Study of Screening for Prostate Cancer, a major, robust study examining the impact of PSA screening over a median period of 13 years on prostate cancer mortality. The eye-opening conclusion was that men who underwent repeated PSA screening were 51% less likely to die from prostate cancer than men who did not undergo screening. 5 If the statistics from this study are applied to the entire population of men aged 55-69 in the United States, PSA screening could potentially save over 80,000 lives in a 13-year period.6
The United States Preventive Services Task Force (USPSTF) published a report in 2012 recommending that men stop undergoing PSA screening.3
Life Extension disagreed with the USPSTF recommendation, particularly as it relates to our members to whom we are steadfastly committed. We know that in the absence of PSA screening, prostate cancer will once again be diagnosed at an advanced stage, when there is painful bulky disease and only a small chance of curative therapy.
The widespread use of PSA testing beginning in 1987 enabled doctors to identify prostate cancer at a greatly reduced stage of disease.7 If the dictum of the USPSTF is followed, a major advance in medicine will be erased.
The Staggering Statistics
Here is what the American Cancer Society says about prostate cancer in the United States:8
- About 238,590 new cases of prostate cancer will be diagnosed in 2013.
- About 29,720 men will die of prostate cancer in 2013.
- About 1 man in 6 will be diagnosed with prostate cancer during his lifetime.
- The average age at diagnosis is 67.
- Prostate cancer is the second leading cause of cancer death among American men.
- About 1 man in 36 will die from prostate cancer.
If prostate cancer were an infectious illness, there would be widespread panic. To put this in perspective, HIV infected less than 50,000 Americans in 2011.9
In 2013, the United States Preventive Services Task Force urged all Americans to undergo routine HIV screening.10
There are valid reasons for HIV screening, but almost five times more Americans are diagnosed with prostate cancer each year compared to HIV.8,9 The same government-funded Task Force that suggests universal HIV screening does not want aging men to benefit from early detection of prostate cancer. They maintain that the treatment is worse than the disease. They confuse the message conveyed by the PSA with the judgment and actions of physicians who too often are programmed toward invasive and expensive therapies.
Do we toss out the baby with the bath water, so to speak, because physicians are not taking the time, or possibly do not have the expertise to advise patients soundly? The actions of the USPSTF and the American Urological Association should be to fix the deficiency of the physician with strict guidelines, just as was done in the 1980s to alter the routine use of the radical mastectomy performed in almost every woman diagnosed with breast cancer.11
The United States Preventive Services Task Force (USPSTF) prefers aging men wallow in ignorance concerning their prostate health, which within the next decade will send death rates spiraling upwards. The USPSTF clearly wants aging men to bury their heads in the sand and not concern themselves about prostate cancer.
The hard statistics showing more than 238,000 newly diagnosed prostate cancer cases annually proves otherwise.8 While the USPTF recommendations will save government health programs billions of dollars in the short term, there will be catastrophic long term costs to pay when record numbers of men who could have been cured instead develop metastatic disease.
Why Life Extension Members Are Different
There are factors that influence mainstream recommendations that do not pertain to Life Extension members. The typical American male over age 60 is remarkably unhealthy, often suffering multiple underlying maladies relating to metabolic syndrome and other pathologies called “co-morbidities.”12 This is indicative of a state of disease in the biologic environment of the patient.
A frank diagnosis (or indication) of prostate cancer should act as an early warning that something is amiss in the patient’s overall health and that further attention is warranted to various systems. Thus a diagnosis of prostate cancer need not be equated with invasive procedures such as radical prostatectomy, radiation therapy, cryosurgery, high intensity focus ultrasound, or androgen deprivation therapy, but with a call to the patient and physician to be alert to pathologic states that if corrected can stabilize or repair some or all of the systems that are amiss.
One reason the USPSTF believes that PSA screening should be halted is that so many men are already in such poor health they are likely to die of some other cause before prostate cancer becomes clinically relevant.3
Cancer Deaths Since Advent
of PSA Screening
This is the opposite of Life Extension members, who go to extraordinary efforts to slow aging and protect against degenerative disease. It would be irrational for healthy Life Extension members to stop PSA screening merely because their age group on average is in such poor overall health.
Few doctors today have comprehensive programs designed to reverse multiple underlying factors that lead to clinically-diagnosed prostate cancer. The typical aging person does not know about lifestyle changes, drugs, and nutrients that may keep an indolent cancer confined to the prostate gland.
Life Extension members have long been armed with this information and have access to health advisors to help guide them to more effective ways of working with their physician to improve their odds of keeping low-grade prostate cancer, or indications of low-grade prostate cancer (such as rising PSA), under control. This issue of Life Extension magazine is dedicated to reminding members and alerting the public about these novel approaches to disease prevention.
Most urologists believe when PSA reaches a certain level that their only choice is to perform needle biopsies. They often overlook existing tests, such as testing and properly analyzing blood results of free PSA percentage, PSA density, and PSA velocity, along with other diagnostics such as PCA3 urinary test and advanced non-invasive techniques that can provide additional insight that may reduce the need for invasive procedures.13-17 Urology patients are not always made aware of these non-invasive choices, and especially of the importance of measuring the PSA rise over time (PSA velocity) to help ascertain if prostate biopsy is warranted.
What clearly separates Life Extension members from the general public, however, are the aggressive steps we take to achieve meaningful extensions of our healthy life spans. Those advising against PSA screening are largely “writing-off” men over age 70.
Life Extension male members need to ensure their prostate health is assessed and maintained at an optimal level for the many decades of extended life they expect.
American Urological Association Capitulates
When the United States Preventive Services Task Force suggested that aging men stop PSA screening altogether, the American Urological Association disagreed. About a year later, the American Urological Association issued revised guidelines that will sharply reduce the number of PSA screenings performed.1,20,21 And other professional groups have issued similar opinions.22
The latest recommendation from the American Urological Association (AUA) is for men over age 70 to avoid PSA screening.1 The AUA is essentially saying that once you move past age 70, your life span is too short to bother with.
The American Urological Association is also writing off men aged 40-54 for prostate screening because of the relative low incidence of cancer in this group compared to men over 54.1 This is a tragedy as it condemns younger men who do develop prostate cancer to probable death. Earlier diagnosis provides a huge advantage when attempting curative therapy. Just ask Prostate Cancer Foundation Chairman Michael Milken, who insisted on a PSA test at age 46 and discovered he had prostate cancer in time to benefit from curative therapy.23
On the flip side are famous people like Frank Zappa, Telly Savalas, Bill Bixby, and other younger men who likely could have identified their prostate cancer earlier had they undergone PSA screening.24 These men probably had rising PSA levels long before metastatic disease manifested.