What the Public Health Message About Prostate Cancer Gets Wrong

Mmost US patients People who have prostate cancer are diagnosed before they experience any symptoms. This may come as a surprise if you’ve ever Googled “prostate cancer.”

Several sites, including some from high-profile medical groups, state prostate cancer is associated with lower-urinary tract symptoms, or LUTS, which include symptoms such as the need to urinate frequently. In reality, these symptoms only occur in a small percentage of prostate cancer patients, usually those with advanced disease.

By emphasizing the need to watch for symptoms, public health messaging puts patients at risk of skipping routine checkups in the absence of clear signs.

According to the American Cancer Society, one in eight men in the United States will be diagnosed with prostate cancer during his lifetime. Most patients will be able to live with the condition, and will not die from it, but prostate cancer is still the second leading cause of cancer death among American men. Regular screening, which includes testing for levels of prostate-specific antigen and, when necessary, by MRI and biopsy to confirm the diagnosis, is important for early detection and careful monitoring.

Before I was diagnosed with prostate cancer in 2010, I was unaware of its “silent killer” reputation. I have never experienced LUTS. Screening showed I had a low-risk case and I took a shot at needing to start close monitoring, known as active surveillance. But if I had waited to watch for symptoms before getting tested, I might not have known how to watch my condition and — if my case had been more severe — might have gotten into a lot more trouble.

Indeed, a recent article published in BMC Medicine suggests that national guidelines and public health campaigns continue to promote the misconception that urinary symptoms are a leading indicator of prostate cancer – despite a lack of consistent evidence to confirm this. . The authors, including Vincent J Gnanapragasam, professor of urology at the University of Cambridge, argue that not only is this helpful, but it may also deter men from coming forward for early testing and detection of potentially treatable cancers.

So why does the myth of LUTS persist?

I think it’s an accident of geography—the prostate is located right next to the urinary system—as well as an ill-considered compulsion to list the symptoms of a condition, even when no symptoms are likely to occur. It is difficult for patients to accept that the disease can be an asymptomatic silent killer and patients may have no warning that cancer is developing in the gland.

Dr. Kevin Ginsberg, urologic oncologist at Wayne State University in Detroit, tells me he often has to explain this to his patients: “The symptoms of prostate cancer and lower urinary tract cancer are very different and united only by the fact that they both affect the prostate.” Let’s include.”

If I had waited to monitor symptoms before getting tested, I would not have known to monitor my condition.

Some organizations are on target with their messaging and do Emphasize the lack of early warning signs. The Prostate Cancer Foundation, for example, notes that “the growing tumor doesn’t push against anything to cause pain, so the disease can be silent for many years. That’s why prostate cancer screening is recommended for all men and their An important topic for families.”

However, that message is confused by other health organizations and websites, which in some ways misrepresent symptoms.

Some mention the silent risks of prostate cancer, but then rush to list LUTS without clarifying that these symptoms rarely occur in patients with advanced tumors. For example, the Centers for Disease Control and Prevention notes that “different people have different symptoms of prostate cancer” and that “some men” have no symptoms at all. Gnanapragasam, lead author of the BMC Medicine article, told me that this statement is not supported by the evidence.

The position is similar at Cancer.net, the patient information website for the American Society of Clinical Oncology, which correctly states that “most prostate cancer does not cause any symptoms” but then advises men to discuss screening. Proceeds to pursue LUTS without giving up. with their doctors until age 55, as recommended by the US Preventive Services Task Force, regardless of whether they have symptoms or not. (The American Cancer Society recommends starting those discussions even earlier: at age 50 for men who are at average risk, and at age 45 for groups that are at high risk, such as blacks.) Men or those with a family history of prostate cancer.)

When I emailed the CDC to ask about its oversight, their spokesperson said the agency will “continue to review the evidence” on the symptoms and “work to clarify the point that prostate cancer may be present.” but asymptomatic, which is why it’s important for many men to discuss prostate cancer screening with their providers.”

Meanwhile, a Cancer.net spokesperson said that it “reviews, updates, and reviews all content on its website with an editorial board of physicians as new evidence and guidelines are published.”

I think a review is in order. I suspect that these sites, which patients rely on, add symptoms in an attempt to be helpful. But in doing so, they perpetuate the misconception that urinary symptoms are common to all patients with prostate cancer.

Worse, other websites may mislead patients or misrepresent facts.

From what I have seen, there are no studies showing a direct link between urinary symptoms and prostate cancer. The fact that these symptoms appear in a small percentage of prostate cancer patients may be a question of correlation rather than causation. Simply put: As men age, many develop an enlarged prostate and many develop prostate cancer. This does not mean that symptoms of an enlarged prostate indicate prostate cancer. In fact, a 2021 literature review suggested the opposite; It found an inverse relationship between prostate size and prostate cancer.

But for example, the National Cancer Institute states that the symptoms of an enlarged prostate “can mimic those of prostate cancer.” This can confuse patients to think that the two conditions cause overlapping symptoms when it is not clear that this is in fact the case.

City of Hope, a cancer treatment center designated by the National Institutes of Health, makes a similar misrepresentation on its website: “Since the prostate lies below the bladder and surrounds the urethra, most prostate cancer symptoms are associated with urinary symptoms.” According to Jnanapragasam, that statement is wrong.

Cancer Treatment Centers of America, a Florida-based network of oncology hospitals and outpatient centers owned by City of Hope, similarly states that LUTS are common in early-stage disease “bladder and urethral cancers because of the proximity of the prostate gland to the prostate.” There can also be a variety of urinary symptoms along with it. Again – there doesn’t seem to be persuasive evidence to back this up.

Patients should be thoroughly examined before any symptoms are detected. Health organizations, no matter how well-intentioned, should not contribute to sending misleading messages that may lead men to avoid routine screening until their cancer is advanced or has possibly spread. Do not go

People need to understand that prostate cancer is a silent disease, especially in the early, treatable stages. Reducing confusion about prostate cancer symptoms — and the lack of it — could save lives.


Howard Wolinski is a medical journalist. He covers prostate cancer on his blog “active observer,” and as a contributor to “MedPage Today.”

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