Wrong public health message about prostate cancer

M.most American patients Patients with prostate cancer are diagnosed before experiencing a single symptom. But it might come as a surprise to anyone who has ever googled “prostate cancer.”

Many sites, including some of the prominent medical groups, state that prostate cancer is associated with lower urinary tract symptoms (LUTS), including symptoms such as the need to urinate frequently. In fact, these symptoms occur only in a small percentage of men with prostate cancer, usually in those with advanced disease.

By emphasizing the need to watch for symptoms, public health messages risk patients skipping routine testing in the absence of clear signs.

1 in 8 men in the United States will be diagnosed with prostate cancer in their lifetime, according to the company. American Cancer Society. most patients However, prostate cancer remains the second leading cause of cancer death in American men.Routine screening, including testing for prostate-specific antigen levels, and MRI and biopsy Confirming the diagnosis is important for early detection and careful monitoring.

It wasn’t until I was diagnosed with prostate cancer in 2010 that Isilent killer“Reputation. I’ve never had LUTS. I dodged the bullet when screening revealed it was a low-risk case.” proactive monitoringBut if I had waited to be aware of my symptoms before being screened, I wouldn’t have known to monitor my condition, and had I had a more serious case, I might have ended up in big trouble. .

Indeed, recent paper Published in BMC Medicine, notes that national guidelines and public health campaigns continue to fuel the misconception that urinary tract symptoms are a major indicator of prostate cancer. Not enough Consistent evidence to confirm this. The authors, including Vincent J. Gnanapragasam, a professor of urology at the University of Cambridge, say this is not only unhelpful, but may discourage men from stepping forward for early screening and detection of treatable cancers. It is claimed that there is even

So why does the LUTS myth persist?

This is a geographical coincidence, the prostate is located right next to the urinary system. I also think it’s a rash impulse to list the symptoms of the condition even when the symptoms are unlikely to occur. It is difficult for patients to accept that there may be no warning that it is happening.

Dr. Kevin Ginsberg, a urological oncologist at Wayne State University in Detroit, told me he often had to explain this to his patients. ”

Some organizations are on point with their messages and doing Emphasize the lack of early warning signs. For example, the Prostate Cancer Foundation Note “For years the disease may go silent because the growing tumor doesn’t push what causes pain. That’s why. sieving Prostate cancer is a very important topic for all men and their families. ”

But that message has been muddied by other health organizations and websites that have misinterpreted the story about symptoms in several ways.

Some refer to hidden risks of prostate cancer, but list LUTS in haste without making it clear that these symptoms rarely occur in patients with advanced tumors. Center Note “Every person has different symptoms of prostate cancer,” and “some men” have no symptoms at all. Gnanapragasam, lead author of the BMC Medicine article, told me that the statement was not supported by evidence.

The situation is similar at Cancer.net, the American Society of Clinical Oncology’s patient information website. situation “Most prostate cancer causes no symptoms at all,” but continues to present LUTS without advising men to discuss screening with their doctor by age 55, regardless of symptoms. appear. (American Cancer Society Recommendation Starting these discussions even earlier: age 50 for average-risk men and age 45 for high-risk groups, such as black men and those with a family history of prostate cancer. )

When I emailed the CDC to ask about its oversight, a spokesperson said the agency “continues to review the evidence” about symptoms and states that “prostate cancer may be present but asymptomatic. We plan to work to clarify the point that it could be sexual, and that’s why it’s important.” For more men to discuss prostate cancer screening with their health care providers.”

Meanwhile, a Cancer.net spokesperson said, “All content on the website is reviewed by an editorial board of physicians who update and revise it as new evidence and guidelines are published.” .

I think the reviews are fair. I suspect that these patient dependent sites are adding symptoms in an attempt to help. perpetuate the erroneous notion that

Worse, other websites may mislead patients or simply misrepresent the facts.

To the best of my knowledge, no studies show a direct causal relationship between urinary symptoms and prostate cancer. It could be a relationship issue. Simply put, as men get older, many develop an enlarged prostate and many develop prostate cancer. It does not mean that it indicates cancer.actually 2021 literature review I suggested the opposite. We found an inverse correlation between prostate size and prostate cancer.

But the National Cancer Institute, for example, situation Symptoms of benign prostatic hyperplasia “may resemble those of prostate cancer.” It may mislead you.

City of Hope, a National Institutes of Health-designated cancer treatment center, makes similar false reports. website: “Most prostate cancer symptoms are associated with voiding symptoms because the prostate lies below the bladder and surrounds the urethra.” According to Gnanapragasam, that statement is inaccurate.

So does Cancer Centers of America, a Florida-based network of oncology hospitals and outpatient centers owned by City of Hope. To tell LUTS is common in early-stage disease, and “due to the proximity of the prostate to the bladder and urethra, prostate cancer can be associated with a variety of urinary symptoms. Again, there is no causative evidence to support this.” seems not.

Patients should be thoroughly screened before symptoms are detected. Medical institutions, however well-intentioned, are complicit in misleading messages that lead men to avoid regular check-ups until their cancer is advanced or even metastasized. Do not.

People need to understand that prostate cancer is a silent disease, especially in its early curable stages. I can do it.

Howard Wolinski is a medical journalist. He covers prostate cancer on his own blog.Active ObserverAs a contributor toMedPage Today“