Dr. Gregory Lomas, Boca Grande Health Clinic urologist, worked in his talk Nov. 14 at the Boca Grande Community Center, to clear confusion stemming from a year-old federal study declaring prostate cancer screenings unnecessary.
The U.S. Preventive Services Task Force advocated against prostate cancer screenings in a 2011 study headed by a pediatrician. Urologists howled.
"No urologists were on that panel," Lomas said.
Dr. Gregory Lomas
Roughly 97 percent of the U.S. urologists came out against this widely reported recommendation, which continues to cause confusion among Americans today. The result: More men at risk of dying from a preventable disease, he said.
Here are excerpts from his talk:
QUESTION: Why is the issue of prostate cancer screenings a controversial subject?
Dr. Gregory Lomas at a glance
Family: Married 35 years with two girls and one boy
Birth date: June 27, 1950
Occupation: board-certified urologist for RTR Urology, 14757 Tamiami Trail in North Port.
Professional: Fellow of the American College of Surgeons. In private practice since 1991.
Education: Two years general surgery and three years urology at Wake Forest University and North Carolina Baptist Hospital in Winston Salem, N.C., finishing as chief resident in 1991. Previously received bachelor's degree magna cum laude in 1972 from the University of Detroit. Received doctorate in 1986 from the University of Michigan.
Career detour: Worked 10 years for Ford Motor Co., following his father's footsteps in various sales, marketing and finance positions before being accepted into medical school.
ANSWER: Last October the government panel recommended that routine prostate screenings just aren't worth it and should no longer be performed on healthy men. They gave is a grade D rating that possible harm outweighs the benefits. Their main focus was monetary benefits. They looked at the amount of money spent on (prostate-specific antigen-based) testing and compared it with how many people died of prostate cancer and concluded it wasn't worth what was being spent on it.
Q: Where did they get this study wrong (besides upsetting almost every urologist in the country?)
A: What they forgot was prostate cancer deaths had actually gone down in the last few years. Results showed we were doing a good job of managing prostate cancer with the tests. I think it actually showed the tests were doing a good job finding the prostate cancer, treating it at an earlier time before they died of the disease and the study failed to take any of that into account.
Q: What was the study's alternative recommendation to prostate screening?
A: The recommendation was, since they said screening is not really a valid tool, was well, you guys figure it out for yourself. They really didn't have any other recommendation.
Q: Hadn't the prostate cancer screenings revolutionized disease treatment for a previously silent killer that gave little warning?
A: Finding prostate cancer went up dramatically when we started using the testing. We found it before it had metastasized or presented as a bump on the prostate. Before the test, a lot of times before you were diagnosed with the screening, it was too late. The disease had already spread. So we have found a lot of prostate cancers (with the test) before men reached that stage.
Q: How big is the problem in the United States?
A: This is the most commonly diagnosed cancer in American men. There were 241,740 new cases last year with 28,170 deaths. One of six American men will get prostate cancer and you have about a 3 percent risk of dying of it. A lot of prostate cancers aren't going to kill you if you get treatment early enough.
Q: The study advocated forgoing a somewhat embarrassing procedure for men so many embraced the findings. What has happened since?
A: If you present with a metastatic disease, 85 percent of men will die within three years. It's important to find it before it spreads.
Q: What is a prostate?
A: It's a walnut-sized gland surrounding the urethra, the small tube that carries the urine from the bladder out. Its job is to produce fluids that nourish the sperm on their journey to wherever they travel
Q: Why is the prostate gland a problem generally for older men in their 50s and up?
A: As you get older the prostate gland grows in size. The larger it is the more it will compress that tube you urinate with and cause a lot of symptoms.
Q: An enlarged prostate doesn't mean you have cancer does it?
A: No. Benign Prostatic Hyperplasia, also known as enlarged prostate, affects most men at some point. It's very common. Twenty-six million men each year are affected by BPH. The good news is that there are options to help.
Q: Does it mean you'll develop prostate cancer at some point?
A: No. It's not an indication or even a predictor of prostate cancer. Prostate cancer and BPH are two totally separate entities. BPH is strictly benign.
Q: What are the symptoms of BPH?
A: You start having frequent urination because your bladder has gotten thicker and stronger from pushing against the enlarged prostate. As it gets thicker and stronger it can't hold as much so you're going more often. You can't empty as completely. You'll have urgency because the big, strong bladder is not a patient bladder. Your urine stream can become weak and it will start and stop. These are all symptoms of BPH. And it affects your quality of life. Golfing, for example, you probably know every tree on the course.
A: What can be done about it?
Q: The options include medication, heat therapy, transurethral resection, laser therapy and, rarely, open surgery.
A: What therapy is showing the greatest success among the most men today?
Q: Laser therapy is relatively new and already is the most popular way to do the surgery with well over half a million patients last year. It's safe. It can be done as an outpatient, gives immediate relief with dramatic flow improvement, vaporizes the tissue and offers little pain. It usually takes about an hour and then you go home. There is the con of an overnight catheter.