One Size Does Not Fit All for Prostate Cancer Treatment

bdhilton

http://www.pcf.org/site/c.leJRIROrEpH/b.8019931/k.58D0/One_Size_Does_Not_Fit_All_for_Prostate_Cancer_Treatment.htm

3/20/2012 - A recent study in the Achieves of Internal Medicine found that during the past decade, some men with low-grade prostate cancer may have been treated with therapies that are too aggressive. The study conducted by Yale School of Medicine researchers, including lead researcher Cary Gross, MD, found that men who are least likely to benefit from treatment—those with short life expectancies and non-aggressive cancers—are more likely to be treated for their cancers than they were a decade ago.

With more than 27 known genotypes, or varieties of prostate cancer, it is vital that each man understands what his diagnostic scores mean and makes informed treatment decisions with his medical team, based upon age, general health and family history. Assessing whether one’s disease appears indolent (non-life threatening) or aggressive is an important step in the process. For many men, the best decision is not to treat immediately but participate in active surveillance. To better inform treatment decisions, PCF has invested more than $5 million in funding for better diagnostics and biomarkers to more accurately pinpoint aggressive versus non-life-threatening cancers so overtreatment can be reduced and more men can be cured.

Several excellent nomograms exists that can help men—of all ages—in the treatment decision process. These are available at:

• Cleveland Clinic: Risk Calculators

• James Buchanan Brady Urological Institute at Johns Hopkins Medicine: The Partin Tables & The Han Tables

• Memorial Sloan-Kettering Cancer Center: Prostate Cancer Nomograms

Kongo

Excellent Material
BD,

This post and a related post of yours (http://csn.cancer.org/node/238009) are excellent points of discussion for men who are in the zone for possible prostate cancer detection such as men in their 50s or older and for men who have been recently diagnosed with prostate cancer.

I think they go hand-in-hand actually. I agree whole heartedly that prostate cancer screening does save lives but that too often an elevated PSA reading triggers actions by family doctors and urologists that are not appropriate such as rushing to biopsy and taking too aggressive actions that result in decreased quality of life for the patient.

In America it seems that many professional voices in the health care field, including the U.S. Preventive Services Task Force, suggest that since PSA screening often leads to unnecessary or overly aggressive treatment that we should not do the test. This conclusion defies any sense of reasonable logic in my opinion.

Undoubtedly in this country too many men do indeed receive unnecessary or inappropriate treatment but it is not the result of PSA testing. It is a rush to "do something" by well meaning physicians (or maybe financially motivated treatment practitioners) and the lack of a counter balancing force anywhere in our medical system that can adequately educate a newly diagnosed patient about what a proper course of action should be.

I've suggested in earlier posts that the system in the USA could benefit from an impartial ombudsman that plays a role in educating and coordinating second opinions for newly diagnosed men before they make a decision about treatment choices. I also believe GPs and urologists need to be more judicious in identifying possible causes of an elevated PSA before pushing patients toward biopsies.

Thanks for sharing this information, BD.

K