It seems we have a national passion for prostate biopsies. A million men are biopsied every year. Two hundred thousand of them will be diagnosed with prostate cancer and about half of these with Low-Risk disease, a condition that can be safely monitored without immediate treatment. Even so, more than half of these men with Low-Risk will undergo prompt, radical treatment. Sadly, irrational fears rooted in the electrifying word “cancer” drive most men into taking immediate action.
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In 2013, the American actress Angelina Jolie made a life-altering decision that fascinated the public and made the cover of Time magazine . Based upon her family history and a genetic blood test for the BRCA1 gene, she was counseled that she had an 87% chance of developing breast cancer. This led to her decision to undergo a preventive double mastectomy. The Time article was titled “The Angelina Effect” and focused on the power of genomic medicine to guide clinical decision making. A family history can be considered part of “clinical information” and would certainly increase the odds of developing breast cancer, but only the genomic test increased those odds such that a preventive procedure became a reasonable strategy.
According to the National Cancer Institute, African Americans may have the highest rates of prostate cancer in the world. Furthermore, black men often develop the disease at a younger age than white men, and the cancer is often more aggressive.
In May 2011, the New England Journal of Medicine reported on 695 men from Sweden, Finland, and Iceland, average age 65, who were randomly allocated to either immediate surgery or delayed hormone therapy (DHT) between 1989 and 1999. The median PSA for the 695 men was 13. Eighty percent of the men had palpable disease found during their digital rectal exam. In the men treated with DHT, hormone therapy was initiated if and when bone metastasis occurred. Bone scans were performed every other year.