For Prostate Cancer, Many Options, Little Certainty

Opinion: The New York Times | 07.19.2009

To the Editor:

“In Health Reform, a Cancer Offers an Acid Test,” by David Leonhardt (Economic Scene column, front page, July 8), misses an essential principle in the genomic age of prostate cancer research: one cost and treatment cannot benefit every patient.

Prostate cancer is not one disease for policy reform: we finance research on more than six molecular and clinical subtypes of prostate cancer. Some are lethal, while others do not require treatment.

We do not yet have tests that can distinguish between the two. Thus, we often overtreat, overburdening the resources of our health care system. Without intensified research now, we can never know perfectly who should receive which treatment.

Some 192,000 American men will receive a diagnosis of prostate cancer this year, and some 27,000 men (one every 19 minutes) will die annually from advanced, metastatic disease.

Prostate cancer provides the ideal place to test policy reform and immediate reinvestment of any savings from waste into research that ends death from prostate cancer.

Jonathan Simons
President and Chief Executive
Prostate Cancer Foundation
Santa Monica, Calif., July 8, 2009

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To the Editor:

While I agree with David Leonhardt’s premise that prostate cancer is an appropriate litmus test for health care reform, I disagree with his analysis of treatment issues.

Mr. Leonhardt defines the “fundamental problem” in health care as “the combination of soaring costs and mediocre results.” That would apply to the expense and results to date with proton therapy, but it certainly does not apply to I.M.R.T. The actual costs of treatment are significantly less than those cited by Mr. Leonhardt. Numerous recent studies have shown that higher doses of radiation delivered by I.M.R.T. eradicate cancer more effectively with dramatically fewer side effects than any other treatment.

Most men who forgo treatment and pursue “watchful waiting” (a.k.a “watchful worrying”) ultimately end up on female hormones as the disease progresses. The hormones are not only extremely costly but also lead to heart disease, hyperlipidemia, diabetes, osteoporosis, cognitive impairment and “andropause” (hot flashes, depression, erectile dysfunction). Treating these hormone-induced maladies is more costly than treating prostate cancer, since they frequently result in mega-medications and repeated hospitalizations.

Those patients still have prostate cancer, and while screening and advances in treatment have lowered the death rate significantly over the past decade, prostate cancer still kills almost 30,000 patients a year. Michael J. Dattoli

Sarasota, Fla., July 13, 2009

The writer is chief physician at the Dattoli Cancer Center and Brachytherapy Research Institute.Copyright The New York Times 2009