Prostate Cancer Needs Early Detection : Medicine: Precious time is being wasted on the debate on the merits of broad screening.

Hospitals and clinics across the country are offering prostate-cancer screening this month for free or substantially reduced cost. At a time when health-care issues are uppermost in our national consciousness, this important service deserves special attention.

The irony is that as more Americans become aware of the benefits of early detection, widespread screening for breast and prostate cancer is controversial. At a time when it remains difficult to win appropriate funding for research into the cause and cure for these diseases, there are those who cling to another approach--let’s pretend we’re doing enough.

Reducing the scope of screening will not reduce the incidence of any cancer. The object of screening is to identify cases that can benefit from early diagnosis. In 1993, breast cancer killed about 42,000 women, while prostate cancer killed about 36,000 men in this country. Many of them might have survived had their cancers been discovered in the earliest stages.

On the issue of breast-cancer screening, informed women are speaking out energetically. Ever since Betty Ford first spoke frankly about her disease, women have understood that open communication is a key element of treatment, that they play a vital role in their own healthy futures and that nothing can be taken for granted.

For men, unfortunately, there is little parallel experience.

Some prominent Americans have been lost to prostate cancer lately, among them musician Frank Zappa and actors Bill Bixby and Don Ameche. Bixby and Zappa, both only in their 50s when they died, were considerably younger than the “typical” prostate-cancer patient. Each acknowledged the nature of his illness--not always the case with prostate cancer--and each apparently was aware that earlier detection might have increased his longevity.

The arguments against broad screening focus on the assertion that it is difficult to demonstrate a relationship between early detection and increased longevity. In the past, studies have not documented such a correlation. But a more recent analysis shows a 3 1/2-year difference, according to Dr. Peter Scardino, chairman of urology at Baylor College of Medicine in Houston.

Two other areas also are the focus of much discussion: the economics of screening and the impacts of treatment.

On the economic front, there is concern that large-scale screening is a “cash cow” for some interests. One view is that as health-care structure is reshaped, reducing the scope of screening will be an important mechanism for reducing costs.

The flip side of that economic argument is the tremendous cost of waiting to treat this disease until it has reached advanced stages. Each year, the federal government spends almost $5 billion in prostate-cancer treatment. The cost of screening is, in fact, an important investment.

But a more sensitive issue is the most intimate one. Some treatment for prostate cancer may cause undesirable side effects, including incontinence and impotence. And in many cases, it’s not at all clear when such treatments are necessary.

Prostate cancer is a mysterious disease. It is present in most men over 60, to at least a minimal degree. In many cases, it grows very slowly over the years and causes no particular symptoms or ill effects.

When the disease occurs in younger men--and 25% of all cases occur in men under the age of 60--it is often more virulent. It metastasizes quickly, leading inevitably to a difficult death.

Not all cases follow these patterns. Unfortunately, no one can predict which cancers will grow and spread and which may languish for years. This poses a dilemma for both doctors and patients: Is it better to suggest a treatment that may affect the most intimate aspects of a man’s life, or to monitor the progress of the disease closely, taking action only if it becomes clearly necessary? Or is it easier to limit screening and reduce the number of times the difficult question arises?

Clearly, the third answer is no answer at all.

The real answer to prostate cancer, as with so many other diseases, is the assurance of an appropriate level of research funding. Only when the cause of this terrible disease is understood will the best possible answer be found.

In the shorter term, the arguments against screening are plainly without merit. It is true that, upon learning they have prostate cancer, some men will face difficult choices. But unless they know and understand their circumstances fully, they will have no choice whatsoever.

I can think of nothing less fair, or right, than that.