Comparing treatments for prostate cancer between countries is like comparing apples to oranges

A study reported in the New England Journal of Medicine and reported on NPR appears to justify surgery for men with “low risk” prostate cancer. However, more careful review of the article revealed that what the Swedes define as “low risk” may be given a “higher risk” diagnosis in the United States. If we used the Swedes definition of “low risk” we would also be performing surgery.

The Swedes don’t use PSA to screen men for prostate cancer; rather, they use digital rectal examinations. Ninety percent of their tumors can be felt by digital rectal examinations. In contrast, most of the tumors discovered here in the USA are detected by elevated PSA levels and less than half are palpable by DRE.

Ninety percent of PSA-detected prostate cancers are considered “low risk” and would seldom cause any problems to the patient. Therefore, many surgeons might recommend “active surveillance” rather than surgery. “Active surveillance” is different than “watchful waiting”. With “active surveillance” biopsies are repeated annuall to diagnose when/if a tumor has grown with the intent to cure; with “watchful waiting” the doctor waits for the tumor to spread before beginning palliative treatment.

Thus, the Swedes “low risk” would be a “higher risk” here in the U.S. and would most likely be treated surgically just like in Sweden.


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