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Ignoring Prostate Cancer Entirely
Prostate Cancer | Last Active: 2 hours ago | Replies (32)Comment receiving replies
Virtually everyone would agree that completely ignoring a asymptomatic PCa diagnosis is not wise; however, I doubt any man, under 80 years old, would take that approach.
The ProtecT (Prostate Testing for Cancer and Treatment) trial, conducted in the United Kingdom, is a landmark randomized controlled trial (the gold standard of medicine) that compared three management strategies for men with localized prostate cancer detected through PSA (prostate-specific antigen) screening:
1) active monitoring (a form of surveillance)
2) radical prostatectomy (surgery)
3) radiotherapy
This RCT concluded that, for men with PSA-detected localized prostate cancer, active monitoring, surgery, and radiotherapy resulted in similarly low prostate cancer-specific mortality and overall survival at 15 years.
In other words, for those diagnosed with localized PCa, it doesn’t matter which approach one decides upon (AS, RP or radiation); your 15 year overall survival rate will be the same.
However, radical treatments significantly reduced the risk of progression and metastasis, however, at the cost of immediate treatment-related side effects.
These findings emphasize the need to weigh the benefits of preventing disease advancement against the harms of treatment, tailored to individual patient circumstances and preferences.
The trial provides robust evidence supporting active monitoring as a safe initial strategy for many men, particularly those with low-risk disease, while underscoring the nuanced decision-making required when opting for immediate treatment.
So I agree that we shouldn’t judge what others decide to do regarding immediate treatment or active surveillance for those diagnosed with localized PCa; but we can rest assured that the best science has confirmed that any of these three decisions will NOT affect a man’s 15 year survival rate prospects.
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Every time I read this study I really scratch my head. And I’ve read it at least 3X because I thought I was reading it incorrectly.
“PSA detected, localized” is sort of an ideal and I have to assume they’re speaking about low Gleason scores as well. When I think of my own situation (Gleason 4+3), surgery 6 years ago, now followed by radiation with ADT I cannot believe that this disease would NOT have killed me if I just watched it for 15 years, you know? But maybe I’ll die anyway, in spite of treatment😳?
I know I am a pessimist, but even an optimist would have been a little concerned with those stats. My cancer was considered localized as well and post op pathology showed negative margins, and no lymphatic spread.
But We’ve all seen how unpredictable the PSMA scan can be, showing NO metastatic areas in post- op salvage situations of PSA 10 or more; so how can any case be deemed “localized” when you can’t see if it’s outside the gland with any great degree of accuracy? Micrometastases simply don’t show.
Maybe if you are age 75 and over, I could see a 15 yr horizon being reasonable for the decision to treat or not - even with a higher PSA - but can a man in his 60’s really roll the dice on this British study?
I am always wary of an overburdened health care system - or an insurance companies recommendations- for cancer detection and treatment.
A few years back insurance companies said that they would only pay for PAP smears every other year instead of annually because it wasn’t ‘necessary’ to screen yearly…two years is plenty of time for uterine cancer to spread.
I could ramble for days about so many other tests and procedures but you get where I’m going…
It’s a great post, though, because it really shows the state of confusion about this disease even at the highest levels of the medical hierarchy.
Best,
Phil