Monday, July 27, 2015

Low-Risk Prostate Cancers

A wide majority of U.S. men with low-risk prostate cancer are being treated for the disease even though “active surveillance” is an option, a new report finds.

The study data was collected in 2010 and 2011, and a lot has changed since that time in regard to the popularity of active surveillance, experts noted.

Active surveillance is “gaining acceptance among urologists and patients,” said study co-author Dr. Hui Zhu, chief of urology at the Louis Stokes Cleveland VA Medical Center in Ohio.

“Age-appropriate men should discuss the risks and benefits of screening with their physicians, and men with newly diagnosed localized prostate cancer should ask their physicians whether active surveillance is a good option for them”, he added

There’s been controversy for years about diagnosing and treating prostate cancer.  Tumors considered to be low-risk may never spread, but men have often been treated anyway.  But those treatments aren’t without risk.  Prostate cancer treatments can cause serious and lasting side effects, such as incontinence and erectile dysfunction, according to the American Cancer Society.

In 2011, the U.S. Preventive Services Task Force discouraged the use of routine prostate cancer testing.  One reason why was because of the odds that low-risk tumors would be treated.  But, despite that recommendation, many doctors continue ordering the prostate-specific antigen (PSA) tests.  Supporters of the test suggest that if the PSA leads to an over diagnosis of low-risk prostate cancers, that problem can be countered with active surveillance, the study authors noted.

The new report examines a national database that includes about 70% of cancer cases in the country.  Older men - those over 60 - were more likely to have active surveillance.  Men without insurance were also more likely to have active surveillance.

“Prostate cancer, even the lethal form, is highly treatable when it is detected at an early stage through the use of screening,” Zhu said.

My Take:
There is the good, the bad, and the ugly to this story.

The good part is that up to 40% of newly diagnosed cases of prostate cancer are considered low-risk and those patients could potentially avoid surgery, chemotherapy, and/or radiation.  Both medical and public opinion is swinging away from the  aggressive approach to prostate cancer.

The bad part is that this shift in medical thinking comes as a reaction to the U.S. Preventive Services Task Force recommendation against performing routine PSA testing.  The more significant reason against routine PSA testing is that urologists were using any mild elevation of the PSA as an excuse to run prostate biopsies.  A large percentage of these surgeries were performed on healthy men, multiple times, as a way to generate income.  How sad that they had to recommend against performing a valid screening test because of such widespread abuse.

The ugly part is that this information was obviously withheld from this study report.  It remains to be seen if this shift in thinking reduces unnecessary prostate biopsies.

The Bottom Line:
This shift in the treatment of prostate cancer is long overdue.  The public needs to get past the brainwashing that all cancer kills.  The medical field has to stop the mixed messages.  They have engrained this concept that cancer kills into the public mind only to offer some hope, if and only if, you follow their aggressive and very expensive form of treatment.  The U.S. still offers the most expensive and least effective health care of all the industrialized nations of the world.

Source: June 30, 2015 National Institutes of Health

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