A diagnosis of prostate cancer is scary enough. But just as scary is that nobody can tell a man the best way to treat it.
This month, the Agency for Healthcare Research and Quality issued a sweeping review of prostate cancer treatments, including surgical removal, radiation, hormone therapy and so-called watchful waiting, which involves careful monitoring but no active treatment until the cancer shows signs of growing.
Because none of these treatments emerged as superior, the agency came to the troubling conclusion that it could not recommend one over the others.
"Having been involved in this area for a long time, it was not shocking, but it is disappointing," said Dr. Timothy J. Wilt, lead researcher on the report, from the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research. "Information is really lacking to determine whether over all one treatment is more effective and preferred."
Prostate cancer is the single most common cancer in the United States and the second most lethal among men after lung cancer. In 2008, the American Cancer Society estimates, 186,320 men will learn that they have it and 28,660 will die from it. The estimates for breast cancer are 182,460 and 40,480.
Prostate cancer is often diagnosed with a blood test that looks for prostate-specific antigen, P.S.A. There is widespread consensus that the test casts too wide a net, resulting in overdiagnosis and overtreatment. And the treatment can be devastating, leaving men impotent, incontinent or both.
"Men don't go into the clinical trials," said Dr. Daniel P. Petrylak, associate professor of medicine and director of the genitourinary oncology program at the Columbia University Medical Center. "That's the whole problem. Patients ask me all the time, 'What is the best treatment?' And I can't give them an evidence-based approach for that, because we don't have the data."
Prostate doctors and patient advocates often compare their cause with that of the other leading sex-specific cancer: one of the largest prostate cancer support groups is called Us Too, a play on the Y-ME National Breast Cancer Organization. The dismal state of prostate cancer research and advocacy pales in comparison to the campaign against breast cancer.
