The PSA test (which I posted about on Tuesday) isn’t the only prostate cancer controversy.
Just as contentious is the debate over what is the appropriate treatment for this disease, which kills 27,000 American men each year.
In Wednesday’s New York Times, reporter David Leonhardt does a great job of explaining the treatment controversy.
Right now, men with the most common form – slow-growing, early-stage prostate cancer – can choose from at least five different courses of treatment. The simplest is known as watchful waiting, which means doing nothing unless later tests show the cancer is worsening. More aggressive options include removing the prostate gland or receiving one of several forms of radiation. The latest treatment – proton radiation therapy – involves a proton accelerator that can be as big as a football field.
Some doctors swear by one treatment, others by another. But no one really knows which is best. Rigorous research has been scant. Above all, no serious study has found that the high-technology treatments do better at keeping men healthy and alive. Most die of something else before prostate cancer becomes a problem.
Yet, as Leonhardt points out, the cost differences for these treatments is huge, ranging from a few thousand dollars (in follow-up medical visits and tests) for watchful waiting to more than $100,000 for proton radiation therapy.
“In our current fee-for-service medical system – in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money,” says Leonhardt.
“The country is paying at least several billion more dollars for prostate treatment than is medically justified – and the bill is rising rapidly,” he adds.
This issue is Leonhardt’s “personal litmus test” for the success (or failure) of the health-care-reform legislation now being debated in Congress. It will determine, he says, if Congress is truly serious about fixing “the fundamental problem with our medical system: the combination of soaring costs and mediocre results. If they don’t, the medical system will remain deeply troubled, no matter what other improvements they make.”
Given the high false-positive rates of PSA testing (results that indicate disease when there isn’t any), watchful waiting may often be the best treatment option for prostate cancer. But it’s not without its hidden costs. According to the editorial in CA: A Cancer Journal for Clinicians (which I referenced in my Tuesday post), even “the strategy of watchful waiting is associated with side effects. It is known that a large number of men with a history of prostate cancer suffer from depression and mental anguish leading to an increased risk of suicide, and these men are at risk of losing health insurance.”