TESTING POSITIVE
Marc B. Garnick’s fine article on prostate cancer [“The Great Prostate Cancer Debate”] neglects one very important consideration in its support of reduced screening: death from untreated cancer, though low, is quite often slow and very painful. I would much rather die of just about anything else.

In addition, treatment of advanced prostate cancer is no cakewalk. My prostate cancer was removed surgically after it was diagnosed, but my brother’s was too far advanced. He is now being treated by hormones and other drugs, and his life is far from rosy: weight gain, hot flashes, heart problems and incontinence are not his only problems. For me, the prostate-specific antigen (PSA) test was a godsend.
Joe Cusack
Scottsdale, Ariz.

The discussion should not be about the many low-grade tumors that elevated PSA tests find but about how many mid- and high-grade tumors are discovered. The fact that elevated PSA scores can indicate the possibility of aggressive cancers in the prostate sooner than any other noninvasive test should justify some per­iodic PSA testing for men. How often these screenings should be done and at what age they should begin is the proper question, not whether they should be eliminated.  
Henry Maze
San Mateo, Calif.

GARNICK REPLIES: Whether prostate cancer screening will reduce the death rates and suffering from prostate cancer forms a key and critical question underlying any screening program. The thinking behind such programs hypothesizes that cancers start as a microscopic focus, turn into a localized cancer—becoming more regionally advanced in the organ from which they arose—then metastasize, eventually claiming the life of the individual. Thus, screening and finding these cancers “early” should result in saved lives. Yet although nearly every screening program finds seemingly less aggressive and earlier-stage cancers than those found later on, the expected improved survival rates have not materialized.

Although it is reassuring to think that “catching” prostate cancer early will save lives, the complexities and differing genetic makeup of prostate cancers that ultimately determine the disease’s biological behavior are probably the most important factors. Oncologists remain hopeful that future biomarkers will be developed that will inform us not only of whether cancer is present but of what the behavior—and hence the need for treatment—of that cancer is likely to be.

2 Comments

1. 1. Mokurai 05:36 PM 5/18/12

   I believe that there is an error in the display of the letter from Raphael Bousso and Leonard Susskind, in the phrase "1070 photons". This should apparently be 10^70, or 1e70, or ten million vigintillion, depending on one's notational preferences, or ten to the seventhieth power if one prefers words.

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2. 2. scientific earthling 10:36 PM 5/19/12

   It is stupidity to treat the science behind the H5N1 virus and its mutations as a grand security threat. The virus is everywhere, any science graduate anywhere in the world can isolate and work on it. Even if the worst should happen all it will do is lower extreme over-population and restore bio-diversity decimated by loss of habitat.
   
   Perhaps we should look forward to such an event, it will ensure the survival of our species and our planet for thousands of years more. Not that it is important. Just as each and every one of us will die, so too will our species.

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