Why Prostate Screening and Treatments Don't Work
By Joel Fuhrman, M.D. www.drfuhrman.com
Approximately 220,000 men were diagnosed with prostate cancer in 2003, but there were only 28,900 deaths from prostate cancer that year. That means even for men diagnosed with prostate cancer, only about 13 percent die because of their cancer. The vast majority of men with prostate cancer will die of heart disease and other causes; this percentage is the same in treated and untreated patients with prostate cancer. The percentage of men dying from prostate cancer has been practically the same for the last fifty years.
Rather than subjecting men to biopsies and attempting to destroy prostate tissue, a more sensible approach would be to teach them the benefits of adopting the only dietary style that has been shown to be protective of all the common causes of death (except accidents)—the vegetable-based diet, rich in high-nutrient plant foods.
Medical studies that seemingly show benefits from prostate cancer screening and treatments are not accurate for many reasons. Let’s look at some of these reasons:
Lead Time Bias—PSA testing leads to men being biopsied and diagnosed with cancer many years earlier than men who were not tested. Studies supporting PSA testing compare the survival rates of men who had their cancers diagnosed and treated after PSA testing to those whose cancers were diagnosed before PSA testing was available. Increased survival rates after treatments in the post-PSA era, when compared with the pre-PSA era, are largely the result of earlier diagnosis and not due to the detection and treatment of prostate cancer. Now that people are diagnosed ten years earlier than they would have been if they hadn’t been encouraged to take a PSA test, it appears that people who have prostate cancer are living longer after diagnosis.
Length Time Bias—PSA testing picks up more of the asymptomatic cancers diagnosed in their early stages that are slow growing and less aggressive, not the ones that progress rapidly and have a narrow pre-clinical stage. Better disease free survival rates in the post-PSA era may be due to finding and treating more of these less aggressive cancers, not because of early detection and treatment.
Selection Bias—Studies that select patients who have had prostatectomy (partial removal of the prostate) and compare them with untreated patients are flawed because they exclude patients who have more advanced disease.
Patients are divided into two groups—those who receive treatment and those who do not, and the two groups are compared. But, in actuality, there are three sub-groups in each of the main groups: a) those who don’t have prostate cancer; b) those who have local (mild) forms that can be treated with prostatectomy; and c) those who have more advanced forms that cannot be treated with prostatectomy.
The problem comes about when researchers exclude the long-term results of the c) subgroup (those most seriously ill and most likely to die prematurely) from the results of the treated group, which makes the treated group look better—and the untreated group look worse—than they really are.
Let’s look at what we would expect to find in two equivalent groups and their subgroups if comparison was done properly. In the a) subgroups (those who don’t have prostate cancer), we expect the long term outcomes to be better in the untreated group, since there is always a risk from surgery (which in this case is unnecessary surgery). In the b) subgroups, those with local (mild) forms of the disease, we would look to see if the treated group had better long-term results. In the c) subgroups, those with more advanced forms that cannot be treated with prostatectomy (the sickest and most likely to have poor long term results), we’d have to exclude them, since they didn’t get the treatment we are studying. Unfortunately, in the selection-biased studies, they are only excluded from the treated group. These sickest of all subjects are left in the results of the untreated group (since without doing other tests or surgery, no one knows who they are), which makes the long term results look better for the treated group and worse for the untreated group. At best, these results are meaningless.
Early Detection Too Late
The 2 percent of men who eventually die of prostate cancer invariably have metastatic disease that has spread to other sites in the body far away from the prostate. Modern urology care attempts to detect prostate cancer early and treat the prostate before the spread of cancer can occur. The main reasons why medical care fails to prevent metastatic disease is that in the case of most of these prostate cancer deaths, we find that the earlier treatment of the prostate cancer was not helpful because it did not address the cancerous cells that had left the prostate years earlier, years before the prostate surgery was performed.
The idea that we can remove the prostate in time to stop the spread of most deadly cancers is wishful thinking and not consistent with the evidence. There is no evidence that a significant number of patients with detectable prostate cancer have that cancer detected and treated right before metastasis would have occurred. The number of men fitting this category is very, very small. Men must accept the fact that in cases of low-risk prostate cancer, local therapy is unnecessary, and that in high risk cases, it is not helpful.
Interestingly, there are now more doctors making a living off of prostate cancer than there are men dying of it. In spite of a massive industry treating prostate cancer with a local attack on the prostate gland, there is not one randomized trial that has ever shown that radical prostatectomy, radiation therapy, or radioactive seed implantation are effective at promoting life extension. I find this astounding, especially since the theory supporting the use of those therapies makes no sense—doctors look to see if the cancer has spread with techniques that cannot see if the spread already has occurred. Then, based on these almost worthless tests, they go ahead and remove or destroy the patient’s prostate. I do not consider this good medicine.
I thought the first rule of medicine was, “Do no harm.” Based on that principle, we should only intervene if the intervention is a clear benefit to the patient. The motto of today’s doctor seems to be, “Don’t just stand there; do something, even if it may damage the patient.”
Influence Of Money
One might ask why it is that physicians and researchers do not recognize that the benefits of prostate cancer treatments have been grossly exaggerated by physicians. The answer is, as in most other industries, benefits of the pharmaceutical/ medical industry’s products— drugs, surgery, and medical care— are almost always exaggerated and distorted to make them appear valuable, and, if possible, necessary. Nutritional excellence does not bring in big profits for this industry, so you rarely hear about it.
The drug industry, the dairy industry, and processed food manufacturers pay big bucks to the commercial media—TV, radio, newspapers, and magazines; big bucks to the scientific researchers to produce and publish supportive articles; and big bucks to the government via lobbyists and political contributions. These industries even payroll the “so-called” experts for government policy panels. It is very unlikely that any part of our commercial information highways will be interested in delivering to the public an anti-cancer diet and lifestyle message that challenges some of its biggest customers—the dairy, meat, processed food, and restaurant industry.