CNN Opinion piece on PCa

www.cnn.com/2014/07/18/health/prostate-cancer-overtreament/index.html

A few quotes from the story (on the CNN online page, running with the Ben Stiller story)

Somebody said...
I must note that while the data show that a large number of men receiving these treatments should not be getting them, these therapies are appropriate for a select group of men. It is the physician's responsibility to tailor treatment to the patient and his cancer. These two studies form a long list of patterns of care studies showing that a number of American physicians who treat prostate cancer are not fulfilling this responsibility.

And

I believe the major reason for the epidemic of unnecessary therapy in America is that many Americans simply cannot accept that there are cancers that do not need treatment. They have trouble accepting it because of all the messages heard over the years about the evils of cancer and all the devastation that we have seen from the disease. Our emotional prejudice against the disease impairs our ability to approach cancer rationally and understand the diversity within the disease.

And last but not least:

Somebody said...
For the doctor seeing individual patients and not examining data from large clinical studies, it is difficult to see and accept that our aggressive therapies could be more harmful than more conservative approaches like observation. This, even when the harms of some of these therapies are better proven than the benefits and some have even been proven ineffective. A few of the doctors guilty of overtreatment may not understand the number and quality of the studies showing that there are "good cancers." But most simply cannot accept the truth.

Here we have a physician holding his colleagues' collective feet to the fire. May his tribe increase!

This is a powerful piece of writing that you have shared, halbert. It seems like it become easier for you to talk about this topic as time has gone by...it was the same for me.

The passages that you have quoted are very noteworthy. I think that this one also hits people sharply on the side of their head:

halbert's article said...
In some instances, unnecessary treatment of prostate cancer is curing some men who do not need to be cured, with significant detriment to their quality of life. The large number of "cured" makes aggressive treatment look good when one does not realize that many of the cured did not need to be cured.

I also like/agree with your call for the progressive thought-leaders in medicine to more vocally "call-out" their brethren who are (still) perpetuating the overtreatment epidemic. I'll add two other powerful examples of "call-outs" from the leaders of different facets of prostate cancer care.

The first quote is from Anthony Zeitman, MD, who was just awarded the ASTRO Gold Medal in July 2016, the highest award given by the radiation oncology group. Zeitman is director of Harvard's radiation program, and was past-president of ASTRO. This quote comes from an ASTRO editorial he wrote while president, admonishing his peers:

Dr. Zeitman said...
A perfect storm of clinical evidence and economic reality has arisen in which urologists and radiation oncologists need to examine the evidence, examine their souls, and start to carefully look at every new patient asking, before anything else—is treatment really needed at all? If it is not, and that will frequently be the answer, then they must be prepared to lead the patient along the less financially rewarding and decidedly unglamorous path of active surveillance. The training of resident doctors has to date been so focused on cure, and the culture of early detection/early treatment so deeply in-grained, that it is little wonder that this shift in thinking is yet to reflect itself in everyday practice.

The second quote is from Mark Scholz, MD, a medical oncologist who treats many men here at HW/PC out of his world-renowned practice Prostate Oncology Specialists. Scholz is co-founder and past president of the Prostate Cancer Research Institute (PCRI, where several HW/PC members recently attended the conference) and is co-author of the book "Invasion of the Prostate Snatchers." This passage admonishing his peers is from the book:

Dr. Scholz said...
Ten years ago the experts believed that immediate curative treatment was needed for every man with prostate cancer.  Today, after 20 years of vigorously detecting and treating every case of prostate cancer, it has become clear that almost half of the 230,000 men diagnosed every year are undergoing radical treatment for a cancer that is incapable of metastasizing.  Now it’s time for the medical community to come to grips with the fact that over a million men in the United States are living with impotence and incontinence for no justifiable reason. This is a disaster of gargantuan proportions.

Shockingly, even though we can now readily identify these harmless cancers, the problem of rampant overtreatment continues. In 2015 another 50,000 men will undergo unnecessary radical treatment. The medical industrial complex that has been gaining momentum for 25 years refuses to confess its tragic errors.  The huge investments in enormously expensive medical equipment need to be paid off.  No one is willing to accept responsibility, make apologies or confess wrongdoing for all the overtreatment.  The existing system is entrenched and the doctors are too comfortable with the status quo.

These, along with the doctor's message you posted, halbert, are powerful, powerful messages.

My crystal ball says that they are finally setting in...more and more are "getting it"...finally.

Post Edited (JackH) : 10/5/2016 9:07:05 AM (GMT-6)

I tend to agree with Dr Brawley, the author of this Cnn article when it comes to early and often unnecessary treatment. As many of us are aware Dr Brawley was an early advocate of the movement to stop early PSA testing. I did not agree with him on the cessation of early psa testing. I still don't.

The answer might be to reexamine the numbers that are considered cancer. There has already been some small movement in that direction. I would hope that men are still given early psa tests, because many of them still get aggressive cancer in their 40's. However I suggest that anything below a Gleason 7 should not be considered cancer until further tests make that conclusion.

In my case with a Gleason 8, treatment was probably in order. I wish I knew more 10 years ago and chose radiation as my primary treatment. I now feel that surgery should be used only in a minority of special cases.

whipporwill,

What I believe, and have said in here before, is this: given several factors--such as a steadily rising PSA over several years--doubling roughly every year, family history, and my post surgical pathology of G7 in all 4 quadrants of the gland--I believe I may have treated early, but likely not unnecessarily. Based on my post surgery pathology, there is no reason to believe that a follow up biopsy a year after the first wouldn't have come back with 50% of my cores at G7. And if it had, it would have triggered treatment then.

And, I've had a great outcome, so I don't have any issues. Further, I did not feel pushed or rushed by anyone. The determination of 'when' was based on personal factors, primarily about wanting to be fully recovered before summer arrived.

Halbert,

Thanks for that clarification. I'm temporarily restricted to a very slow internet connection and had not read your excellent "My Story" entries until just yesterday. In fact I've still not finished that reading.

Your treatment decision makes perfect sense. I'm still on the cusp of deciding whether or not to leap into definitive treatment and wish the matter were clearer for me. Indeed!

Whippoorwill

My urologist and oncology urologist both said that if my cancer was GS6 that they would not do surgery. Unfortunately I had GS7 (3+4) and both said that there isn't a rush but that I should get it treated one way or another.