Prostate Cancer: Over diagnosis in Solid Organ Transplant Recipients
Prostate Cancer is a cancer in a man’s prostate, a small walnut-sized gland that produces seminal fluid. A urologist is a physician who specializes in conditions affecting the urinary tract (which includes the kidneys, ureters, bladder and urethra) as well as conditions affecting the male reproductive system (which includes the prostate gland, scrotum, testicles and penis).
After skin cancer, prostate cancer is the most-diagnosed form of cancer for men in the United States. It is the second leading cause of cancer death in U.S. men. However, most cases grow slowly and do not cause symptoms, even if untreated. About 90% of cases are localized, meaning that the cancer is confined to the prostate gland and may not spread to other parts of the body. This is especially true in men diagnosed currently by blood testing for PSA.
The researchers conducted a systematic review of 67 studies to compare the effectiveness of watchful waiting versus radical prostatectomy, along with several other treatments. The review is one of the first studies to look at very long-term results.
The results showed that watchful waiting may increase the risk of both the spread of cancer and death from cancer, compared with surgery, in men with clinically detected cancer. Importantly, the studies comparing the two treatments were long-term studies, looking at results over 20 years, begun before PSA testing became common. Clinical detection of prostate cancer relies on physical examination and biopsy. PSA testing, on the other hand, can detect cancer earlier and find smaller, slower-growing tumors. PSA testing is able to diagnose prostate cancer up to five years or so before it would be clinically detectable.
Different studies reviewed found varying levels of risk: overall, after 20 to 25 years, watchful waiting was linked to an increase in death from any cause of 5% to 15%, and an increase in cancer-related death of 4% to 10%. However, patients undergoing watchful waiting had lower rates of urinary and erectile dysfunction than those who underwent radical prostatectomy.
