What public health messages are wrong about prostate cancer

Mmost American patients who have prostate cancer are diagnosed before they have a single symptom. This might come as a surprise if you’ve ever googled “prostate cancer”.

Many websites, including some from high-profile medical groups, claim that prostate cancer is associated with lower urinary tract symptoms, or LUTS, which include signs such as a frequent need to urinate. In reality, these symptoms only occur in a small percentage of prostate cancer patients, usually those with advanced disease.

By emphasizing the need to be aware of symptoms, public health messages run the risk of patients skipping regular checkups in the absence of clear signs.

One in eight men in the United States will be diagnosed with prostate cancer in their lifetime, according to the American Cancer Society. Most patients will be able to live with the disease and not die from it, but prostate cancer is still the second leading cause of cancer death among American men. Regular examinations, which involve testing for prostate-specific antigen levels and followed, if necessary, by MRI and biopsy to confirm the diagnosis, are essential for early detection and careful monitoring.

Before I was diagnosed with prostate cancer in 2010, I was unaware of its “silent killer” reputation. I never experienced LUTS. I dodged a bullet when screening revealed that I have a low-risk case and needed to start close monitoring, known as active surveillance. But if I had waited to watch out for symptoms before getting tested, I wouldn’t have known how to keep an eye on my condition and – if I had a more serious case – I could end up in trouble.

In fact, a recent article published in BMC Medicine points out that national guidelines and public health campaigns continue to promote the misperception that urinary symptoms are an important indicator of prostate cancer – despite the lack of consistent evidence to back this up. . The authors, including Vincent J. Gnanapragasam, professor of urology at the University of Cambridge, argue that not only is this pointless, but it could also prevent men from presenting themselves for early testing and detection of a potentially treatable cancer.

So why does the LUTS myth persist?

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

The Doctor. Kevin Ginsburg, a urological oncologist at Wayne State University in Detroit, told me that he often has to explain this to his patients: “Prostate cancer and lower urinary tract symptoms are very different and are united only by the fact that both involve the prostate. 🇧🇷

If I had waited to be aware of symptoms before getting tested, I wouldn’t have known how to keep an eye on my condition.

Some organizations are on target with their messages and don’t emphasize the lack of warning signs. The Prostate Cancer Foundation, for example, notes that “the growing tumor doesn’t push anything to cause pain; therefore, for many years, the disease can be silent. That’s why prostate cancer screening is such an important topic for all men and their families.”

However, this message is confused by other health organizations and websites that, in some ways, misinterpret the story about the symptoms.

Some mention the silent risks of prostate cancer, but quickly list LUTS without making it clear 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, the lead author of the BMC Medicine paper, told me that the claim is not supported by the evidence.

The situation is similar on Cancer.net, the patient information site for the American Society of Clinical Oncology, which correctly states that “most prostate cancers do not cause any symptoms” but goes on to expose LUTS without advising men to discuss screening with your doctors at age 55, as recommended by the US Preventive Services Task Force, whether or not these symptoms appear. (The American Cancer Society recommends starting these discussions even earlier: at age 50 for average-risk men and age 45 for high-risk groups, such as black men or men with a family history of prostate cancer.)

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

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

I think the criticisms are in order. I suspect that these sites, which patients depend on, add symptoms in an effort to be helpful. But in doing so, they perpetuate the false notion that urinary symptoms are common in all prostate cancer patients.

Even worse, other sites can mislead patients or simply distort the facts.

From what I’ve seen, there are no studies showing a direct causal relationship between urinary symptoms and prostate cancer. The fact that these symptoms appear in a small percentage of prostate cancer patients may simply be a matter 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, the 2021 literature review suggested the opposite; found an inverse correlation between prostate size and prostate cancer.

But the National Cancer Institute, for example, states that symptoms of an enlarged prostate “can be like symptoms of prostate cancer.” This can lead patients to mistakenly think that both conditions cause overlapping symptoms when it’s unclear whether this is actually the case.

City of Hope, a cancer treatment center designated by the National Institutes of Health, makes similar misstatements on its website: “Because the prostate sits below the bladder and surrounds the urethra, most signs of prostate cancer are linked to urinary symptoms”. According to Gnanapragasam, this claim is inaccurate.

The Cancer Treatment Centers of America, a network of Florida-based cancer hospitals and outpatient clinics owned by City of Hope, also states that LUTS are common in early-stage disease “due to the proximity of the prostate to the bladder and urethra. , Cancer can be accompanied by a variety of urinary symptoms”. Again – there doesn’t seem to be causal evidence to support this.

Patients must be screened well before any symptoms are detected. Health organizations, however well-intentioned they may be, should not contribute misleading messages that could lead men to avoid routine checkups until the cancer has advanced or possibly spread.

People need to understand that prostate cancer is a silent disease, especially in the early and curable stages. Decreasing confusion about prostate cancer symptoms — and lack thereof — could be life-saving.

Howard Wolinsky is a medical journalist. He covers prostate cancer on his blog “The Active Vigilante”, and as a contributor to “MedPage Today”.

What public health messages are wrong about prostate cancer

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