Over-diagnosis and Over-treatment Lead to Changes

Fall 2013

Rodney Davis, M.D.

Conventional wisdom says that finding cancer early leads to the best outcomes. But the more researchers have learned about prostate cancer the more it has bedeviled doctors and patients.

Rodney Davis, M.D., who leads the Department of Urology in the UAMS College of Medicine, said patients are counseled differently today than just a few years ago.

“Prostate cancer is a mixed bag,” Davis said. “About 85 percent of men with prostate cancer will never die of the disease. Others will die regardless of when you actually diagnose it.”

Since about 1990, screening for prostate cancer has involved the prostate specific antigen (PSA) test. A high PSA score or rising PSA have been used as indicators of prostate cancer, but the PSA does not distinguish between cancers that are deadly and those that are not. It also may produce false positives and false negatives.

In May 2012, the U.S. Preventive Services Task Force recommended against the PSA screening, saying the test may result in over-diagnosis and over-treatment because “most prostate cancer is asymptomatic for life,” and treatments involve risks of complications.

The American Cancer Society also recommends against the PSA screening unless patients have consulted with their doctor and received information about the uncertainties, risks and potential benefits of screening. This discussion for men at average risk for prostate cancer should occur at about age 50 and as early as age 40 for men with more than one first-degree relative (father, brother or son) with prostate cancer and men of African descent.

“It is called shared decision making,” Davis said. “We talk to patients and let them know the risks and benefits.”

Given the uncertainty of the PSA and the fact that 85 to 90 percent of prostate cancer patients won’t die of the disease, Davis said it’s important that they understand all that’s involved with biopsy, surgery and radiation and the associated risks for erectile dysfunction and incontinence.

“Quality of life is a big issue,” he said.

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Rodney Davis, M.D., counsels a patient about treatment options for prostate cancer.

The nature of prostate cancer is that it can slowly come back, usually years after initial treatment. This has led Davis, who joined UAMS in 2012, to establish the Advanced Prostate Cancer Clinic for men whose cancer has returned. Davis recently saw an 81-year-old patient with recurrent cancer 10 years after a radical prostatectomy. After considering the patient’s age, that he was already incontinent and radiation was likely to make the condition worse, the decision was made to forego treatment but to provide ongoing surveillance.

Davis is an internationally recognized expert in minimally invasive techniques for the treatment of urologic cancers. He leads a team with two additional urologic oncology surgeons whose advanced training enables UAMS to offer the latest minimally invasive treatments: Mohamed I. Kamel, M.D., and Matthew D. Katz, M.D.

“Our main focus is to treat urological cancers using techniques that allow us to return patients to normal activities as quickly as possible,” Davis said. “We want to decrease their length of stay in the hospital, and most importantly enhance their long-term survival.