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This forum is for the discussion of anything to do with Prostate Cancer.
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Outdated Thinking

While I rarely post these days, I feel compelled to do so at this time. I still read YANA daily, and I am distressed to see the trend of the site turn towards old school, outdated thinking that must have our late founder and mentor turning over in his grave.

Now, everybody is entitled to their opinion. I believe that firmly, and a respectful discourse has always been welcome here. So, I am writing to say that, for those who espouse treatment regardless of Gleason grade and other relevant criteria, while I respect your right to your voice your opinion, it is outdated thinking that is not supported by the results of relevant medical studies. That is why the National Comprehensive Cancer Network (or NCCN, for short), which is a non-profit alliance of 25 of the world’s leading cancer centers, supports Active Surveillance (AS) for “very low risk” and “low risk” PCa patients regardless of age.

Here is a case in point. I was just contacted by a 51 year old man diagnosed as a G6 with one 10% core and his urologist recommended treatment. He was smart enough to seek a second opinion from MD Anderson and he is now on AS, as he should be. As I told him in my reply “it disturbs me when I read of local doctors still recommending treatment to very low risk, or low risk, patients because of their age, and yet it goes on all the time, resulting in millions of men being over-treated for the disease”. In my opinion, and far more importantly, in the opinion of top doctors in the know, it is wrong to march millions of very low and low-risk men into the treatment room because of what might happen, however unlikely (despite the horror stories of someone who paid the price for choosing quality of life over treatment that often seem to accompany the pro-treatment argument). Citing a single example, or even several individual examples, is a weak argument, and the results of the larger studies show that to be true.

I just want to add that Terry was a pioneer that was ahead of his time in his position on AS, and the large, respected cancer centers have finally come around to accept the facts that they could no longer ignore. While he always invited opposing viewpoints, he steadfastly countered in favor of AS when he felt it was appropriate to do so, even in the face of derision from some of the posters of the time. So, it is sad to see YANA take a step back, in my opinion, since I am constantly reading the pro-treatment argument, especially of late, without the rebuttal that that outdated mindset cries out for. So, I am putting in my two cents worth at this time and encourage other AS supporters to do the same, if for no other reason than to honor Terry’s legacy (even though the biggest reason is so that new patient seeking help can read both sides of the argument and use that information to make up their minds…because, right now, reading the input on the forum is the same as that 51 year old man, mentioned above, going into the old school urologist’s office and being led by the hand right into the treatment room).

In closing, I want to say to Warwick Ford that, I too, am sorry to read about your brother, but, in my opinion, the important lesson to be learned from it is that, if someone in your family has PCa, then you are at a greater risk and, therefore, it is unwise not to get yourself checked out. To take that sad example, and use it to support a pro-treatment for all argument is misleading, and therefore wrong.

Alan M in the USA

Re: Outdated Thinking

Thank you for this, Alan.
I could not agree more about keeping AS as a primary consideration for those of us in the Very-low and Low risk category. Also impossible to overstate how much I miss Terry's sage advice and guidance.
Quick note: I'm doing fine, will be updating my story soon. Latest PSA little changed, awaiting semi-annual visit with urologist.

Re: Outdated Thinking

It has nothing to do with doctors, it is up to the individual if he can live with cancer in the body (fast or slow) ER

Re: Outdated Thinking (Rebuttal)

It is hard to argue with the statement that it is up to the individual to decide if he can live with cancer in his body, but the comment about it having nothing to do with the doctors has me shaking my head. So, I have included the following information from a 2014 article on the Healthline News website that shows the large role that doctors play in the over-treatment problem:

“Only one-fifth of men older than 65 diagnosed between 2006 and 2009 with low-risk prostate cancers got the recommended, noninvasive "watch-and-wait"** treatment, according to one of the studies”.

**Note (this is me talking): the article uses the term “Watch and Wait” in error, since that is not the same as AS (“active surveillance” is all about “curative intent”, while “watchful waiting” is not!). Back to the article now.

“Treatment Depends on the Doctor”

“The researchers — doctors at the MD Anderson Cancer Center in Houston — wanted to know why. They found that doctors who performed radiation and surgical treatments were more likely to prescribe them to patients with non-aggressive cancers.

At one extreme, one urologist treated all but 5 percent of patients, while at the other, one urologist treated just 40 percent. Patients of urologists who also treated higher-risk prostate cancers were more likely to get the same invasive treatments. And consulting radiation oncologists were even more likely than urologists to treat non-aggressive cancers.

Doctors and other experts note that patients, uneasy doing nothing about the dreaded C-word, sometimes ask for more aggressive treatments. This study suggests that doctors, whether influenced by financial incentives or by a genuine belief that more is better, also drive more aggressive interventions.

But over-treating might be on the decline, the study also showed: Doctors who graduated from medical school more recently were less likely than their older colleagues to treat non-aggressive prostate cancers”.

That is the end of the article. I just want to close by saying that the last sentence in the article is why I have labeled the over-treatment problem as “old-school, outdated thinking”. Thankfully, though, times are changing for the better…however slowly. One thing is for certain, though, and it applies to now, as well as later, and that is that the best defense against over-treatment is to educate yourself going in so that you don't become a victim of this ongoing problem. Sadly. though, many men do not. They follow the doctor's recommendation, without question, because they truly believe the doctor knows best. It is unfortunate for them, but they don't know any better, and that is why the doctor who does (or, at least, should) bears most of the responsibility, in my opinion.

Alan M in the USA

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