When he ran for president in 2008, Mayor Giuliani made the claim that he was lucky to be treated for his prostate cancer as a citizen of the United States because the survival rate was 82 percent, compared to 44 percent in Britain. While these statistics are technically accurate, a closer look at them will show why they do not show the entire picture, and the reason is early detection.
Early detection for a potentially fatal disease seems like a good idea, but use of the Prostate Specific Antigen (PSA) as an early detector for prostate cancer can actually be more damaging than it is helpful. This affects survival rates by pushing the diagnosis age earlier, and thus making it appear as though a higher number of men are cancer-free for the required number of years.
The reality, however, is that a higher number of men are diagnosed early, and thus appear to survive longer than those who are diagnosed in the later stages of the disease. In fact, this common screening method can lead to an over-diagnosis of the disease. Why is this important? Early detection may not save as many lives as it appears to. Men with a positive PSA test may have tumors that will not cause health problems. However, the idea that they have “cancer” will cause many of these men to seek a misguided treatment. All treatments can lead to a significant change in quality of life, and the negative side effects of treatment can last for the rest of a man’s life. Men who have an early stage prostate cancer diagnosis need to understand the risks associated with treatment. Often, no treatment is required as many prostate cancers behave noncancerous. Most of these men can be monitored through active surveillance.