PC: GUIDELINES for who needs treatment, who does not.

1-The men and women at posting at HealingWell/PC are not amongst the world's recognized PC experts.  [edited] 2-One of the best ways, therefore, that we can help support each other, and the newcomers who enter our site on a daily basis, is to share the statistical results, summaries and publications of the professionals who are the recognized experts in the profession.   3-When we work together to push this valuable information out to the HW site, others benefit.   4-One of the most valuable tools—and it is intended to be a tool—for men newly diagnosed with PC is the NCCN * Prostate Cancer Guidelines for Patients ( LINK ).   5-The NCCN experts state that the “risk group” be used as the “foundation to start talking about treatment options.”   6-The “risk group” (high-, intermediate-, low- and very low-risk) is based solely on the set of pre -treatment case characteristics   7-Later in this thread, or perhaps in another thread, I would welcome others to comment about the intermediate-risk and high-risk NCCN recommendations.   8-Actually, the fact is that many HW threads already exist for intermediate- and high-risk cases.   9-In fact, the vast majority of PC research dollars are spent on testing & evaluating the lift-prolonging targeted treatments primarily for high-risk cases and first-line surgical and radiotherapy treatments primarily for intermediate-risk cases.   10-Given this backdrop, I feel that the low-risk cases are the most overlooked set of men, yet they comprise the largest single sub-category of the newly diagnosed.   11-As a result of the circumstances described above, a significant percentage of the low-risk men have suffered the consequences of what we recognize today as PC “overtreatment.”   12-Overtreatment occurs when a man elects an aggressive treatment for a condition which, if left alone, monitored and unchanged, would not otherwise affect his longevity.   13-Aggressive PC treatments result in side effects for all men(sometimes called "harms," especially in the cases of overtreatment), and severe side effects in a sub-set of men.   14-Overtreatment is a concept only applicable to men with “favorable-risk” cases, which is one of the key reasons that a proposal to change the name of “favorable-risk” cases has gained momentum in the profession and is a frequent topic of discussion at the applicable scientific gatherings of the industry leaders.   15-Most estimates are that over a million men living today in the US have been overtreated for PC; some estimates approach 2 million.   16-It should be noted that these statistics include all men who may have had full understanding (or any degree of less than full understanding) in advance that aggressive treatment for low-risk PC was not going to alter their longevity, and that any choice on their part to undergo aggressive treatments was therefore “elective.”   17-From the profession’s big picture perspective on counting the statistics, it matters not whether the patient choose to be overtreated; only what their case characteristics were.                    18-One of the most misunderstood aspects of the NCCN guidelines for PC is that Active Surveillance is one of the recommendations for low-risk men of ALL ages; and in fact AS is absolutely the ONLY recommendation for men in the very low-risk category with up to 20-years additional life expectancy.     20-Recognizing that low-risk (including very low-risk) cases are the most common of newly diagnosed men, patient forums like HW can be a powerful force in helping to reduce overtreatment.   21-Overtreatment will not likely be completely eliminated because some men will likely continue to “elect” an aggressive treatment with full knowledge of the impact to their longevity, but by working together we can help some men avoid the possible “treatment regret” which we sometimes see on the pages of HW.     * 22-NCCN is the National Comprehensive Cancer Network, a not-for-profit alliance of 25 of the world’s leading cancer centers dedicated to improving the quality, efficiency and effectiveness of care for patients with cancer.   23-Clinical Practice guidelines, the core resource published by NCCN, are the recognized standard for clinical policy in cancer care, and are the most thorough and most frequently updated clinical practice guidelines available.   24-Clinical practice guidelines are developed by a select group of specialists in each field to explain a disease and determine the best way to treat a patient, depending on their diagnosis, disease stage, and other factors.   25-NCCN also publishes an easy-to-understand guideline for the general public to help patients with cancer talk with their physician about their care.   I have taken additional time to number each and every one of the 25 sentences in this posting.   Please do feel free to be quite specific in raising any question or value-added comment.       Post Edited (JackH) : 8/20/2014 3:29:49 PM (GMT-6)