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Prostate Cancer Images

Psychoneuroimmunoendocrinology describes the unity of mental, neurological, hormonal and immunological functions, addressing the impact of cognitive images of the mind (whatever its elusive definition) on the central nervous, endocrine and immune systems. It encompasses biofeedback and voluntary controls, impacts on physiology of thought and beliefs, past and present stress, placebos, social relationships and "energy medicine." This column highlights cogent studies from these arenas regarding holistic medicine in the new millennium.

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In US men, prostate cancer is the most common noncutaneous cancer and the second leading cause of cancer death. Data on screening outcomes is controversial. After extensive review of the literature, these authors found no conclusive direct evidence showed that screening reduces prostate cancer mortality. Some screening tests can detect prostate cancer at an earlier stage than clinical detection. One study provided good evidence that radical prostatectomy reduces disease-specific mortality for men with localized prostate cancer detected clinically. No study has adequately examined the additional benefit of earlier treatment after detection by screening. Men with a life expectancy of fewer than ten years are unlikely to benefit from screening even under favorable assumptions. Each potential treatment for prostate cancer is associated with several well-documented potential harms.

Harris R, Lohr KN. Screening for prostate cancer: an update of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002 Dec 3; 137(11):917-29.

COMMENT: Although potential harms of screening for prostate cancer can be established, the presence or magnitude of potential benefits has not been adequately quantified. Any net benefit of screening cannot be determined. In many areas of medicine, a logical premise exists, such as the commonly held theory that early detection of a given disease should always result in early treatment and better outcomes. Often the leap to such a conclusion is made before controlled studies have actually shown the beneficial result to be the case. Oncologist John Cairns concluded in the 1980s that fewer than 50% of cancer patients are cured by surgery and that, aside from Hodgkin's disease, childhood leukemias and a small number of other cancers, no decrease in mortality rates has resulted from chemotherapy. He estimated that only 2-3% of the 400,000 people dying yearly of cancer had derived any benefit from their adjuvant chemotherapy (Sci Am 1985; 253:51). And, more recently, Gotzsche and Olsen (Lancet 2000; 355:129) reviewed the Swedish data from Sjonell and Stahle (Lakartidningen 1999; 96:904, 908) which had found no decrease in breast-cancer mortality in Sweden resulting from near-uniform mammographic screening since 1985. Their Swedish meta-analysis showed a minimal decrease in breast-cancer mortality but a significant increase in total mortality. Decisions regarding prostate cancer need to be individualized. In young men it can be very aggressive compared to the indolent cases found in men over 70.

by Robert A. Anderson, MD

614 Daniels Drive NE

East Wenatchee, Washington 98802 USA

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