Posted April 9, 2009

Don’t skip the screen

Cancer and complacency is a dangerous combination. So says Temple urologist Jack Mydlo, M.D., FACS, in response to recent news articles questioning the need for prostate exams.

The article cited the Prostate, Lung, Colorectal and Ovarian (PLCO) study, as reported in the New England Journal of Medicine, which demonstrated no statistical difference in the risk from dying of prostate cancer in those men who had screening versus non-screening for the disease.

“That medical study, as reported by the NEJM, could, unfortunately and I believe mistakenly, be relied upon by patients who decide not to undergo routine screenings,” said Mydlo, chair and professor of the department of urology at Temple University School of Medicine.


“The study did not, among other things, differentiate for certain increased risk groups, such as African Americans, or men with a family history of prostate cancer.”

Moreover, Mydlo adds, the length of the study was seven to 10 years, a relatively short span for this slow-growing disease. If studied longer, he believes, more meaningful data could have been extrapolated.

“While PSA may not be the be-all and end-all of tumor markers, when combined with digital rectal exams it has been shown to detect prostate cancers at earlier stages of progression than those detected in non-screened patients,” said Mydlo. “This may be of significant benefit to a young man with a long life ahead of him who is just diagnosed with the disease.”

Mydlo points out that the “one size does not fit all” mentality applies to every study, and that treatment of any disease, including prostate cancer, has to be determined on the individual's medical status, age, and the extent of the disease.

“My concern is that the public, some of whom are already somewhat fearful of going to the physician's office for a periodic exam, can use information such as in this article to reinforce their reluctance to be evaluated at all,” said Mydlo. “This information should be used in conjunction with a discussion with a physician to make an informed decision based on the specific risks for each patient.”