Men with recurring prostate cancer not dying from prostate cancer
Prostate cancer is the second most common cancer in men (second to skin cancer). It is well established that the death rate from prostate cancer is quite low:
- Men in the U.S. have a 16% lifetime chance of being diagnosed with prostate cancer, but only a 3% chance of dying from it.
- The five-year and ten-year relative survival rates for prostate cancer are over 99% and 91%, respectively. 
- The primary causes of death of men with prostate cancer are cardiovascular disease and other cancers.
After treatment for prostate cancer (either radiation or prostatectomy), prostate-specific antigen (PSA) levels continue to be monitored. If PSA begins to increase, this is called “biochemical recurrence” (BCR) of prostate cancer.
Biochemical recurrence and mortality
A study in U.S. veterans attempted to figure out how biochemical recurrence affected risk of dying from prostate cancer. Six hundred twenty three men were followed for 15 years after being treated for prostate cancer. In this study, 37% of men who were treated with prostatectomy and 48% of men who were treated with radiation experienced BCR.
Overall, a total of 387 men had died within 15 years – 48 of these men died of prostate cancer, representing 12% of total deaths. For men who underwent prostatectomy and experienced BCR, the total rate of death within five years was 34%, and the rate of prostate cancer death was 3%. For radiation and BCR, death rate within five years was 35%, and prostate cancer death rate was 11%.[4, 5]
In short, the researchers came to the conclusion that the probability of dying from prostate cancer, even after biochemical recurrence, is relatively small. They mention that their findings are in agreement with the often quoted phrase “most men die with prostate cancer, not of it.”
Since BCR is defined as an increase in PSA following treatment, this data also suggests that PSA levels may not be an accurate predictor of risk after treatment. Further studies will likely examine this issue.
Routine PSA screening
Routine PSA screening is known by the scientific community not to be as accurate or valuable as the public is led to believe. About 70% of men with elevated PSA do not actually have cancer, and PSA screening is not thought by scientists to reduce prostate cancer-related deaths.[6-8] Richard J. Ablin, who originally discovered PSA in 1970, called PSA screening a “hugely expensive public health disaster” in a New York Times editorial. Dr. Ablin supports his assertion with these facts:
- FDA approval of PSA tests occurred largely in response to a study that found that PSA screening was only able to detect 3.8% of cancers, and that blood PSA levels may be elevated due to a number of factors, such as drug use, infections, and benign prostatic hyperplasia (BPH).
- The U.S. Preventive Services Task Force, the American College of Preventive Medicine, and the American Cancer Society do not recommend routine PSA screening. However, PSA screening is still routinely used.
Men should not rely on PSA screening as a method of “early detection” to prevent prostate cancer. Rather they should avoid the cause of prostate cancer. Diets high in vegetables (especially cruciferous vegetables and tomato products) and fruit, and low in dairy products, meat, and processed foods, are known to be protective.[9-11] Living and eating healthfully protects against prostate cancer, as well as the other chronic diseases common to Americans (such as heart disease, strokes, and colon cancer) – the same diseases that kill most men with prostate cancer. For those who already have prostate cancer, a healthy, plant-based diet is effective at halting progression of the disease.[12-15]
1. Ablin, R.J., The Great Prostate Mistake, in New York Times. 2010. p. 27.
2. American Cancer Society. What are the key statistics about prostate cancer? 06/30/2010 09/02/2010]; Available from: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-key-statistics.
3. Ketchandji, M., et al., Cause of death in older men after the diagnosis of prostate cancer. J Am Geriatr Soc, 2009. 57(1): p. 24-30.
4. Uchio, E.M., et al., Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med, 2010. 170(15): p. 1390-5.
5. Harding, A. Even when prostate cancer returns, most survive. Reuters Health 08/25/10; Available from: http://www.reuters.com/article/idUSTRE67O4RR20100825?feedType=nl&feedName=ushealth1100.
6. Esserman, L., Y. Shieh, and I. Thompson, Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA: The Journal of the American Medical Association, 2009. 302(15): p. 1685-1692.
7. Coldman, A.J., N. Phillips, and T.A. Pickles, Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity. CMAJ, 2003. 168(1): p. 31-5.
8. Andriole, G.L., et al., Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 2009. 360(13): p. 1310-9.
9. Steinbrecher, A., et al., Dietary glucosinolate intake and risk of prostate cancer in the EPIC-Heidelberg cohort study. Int J Cancer, 2009. 125(9): p. 2179-86.
10. van Breemen, R.B. and N. Pajkovic, Multitargeted therapy of cancer by lycopene. Cancer Lett, 2008. 269(2): p. 339-51.
11. Ma, R.W. and K. Chapman, A systematic review of the effect of diet in prostate cancer prevention and treatment. J Hum Nutr Diet, 2009. 22(3): p. 187-99; quiz 200-2.
12. Frattaroli, J., et al., Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology, 2008. 72(6): p. 1319-23.
13. Ornish, D., et al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A, 2008. 105(24): p. 8369-74.
14. Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. J Urol, 2005. 174(3): p. 1065-9; discussion 1069-70.
15. Fuhrman, J., Dr. Joel Fuhrman Case Study Series: Prostate Cancer.