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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.
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.
